scholarly journals The Benefit of Inevitably Delayed Surgical Intervention Following High-Velocity Maxillofacial War Injuries

2020 ◽  
Author(s):  
Daniel Oren ◽  
Amiel A Dror ◽  
Adeeb Zoabi ◽  
Adi Kasem ◽  
Lior Tzadok ◽  
...  
Keyword(s):  
Civil War ◽  
High Velocity ◽  
Medical Center ◽  
Fistula Formation ◽  
Complication Rates ◽  
Retrospective Case ◽  
War Injuries ◽  
Oroantral Fistula ◽  
Syrian Civil War ◽  
Delayed Group

Abstract Background: Over 3200 Syrian patients were admitted and treated at Galilee Medical Center (GMC) over a five-year period (May 2013 - May 2018) since the beginning of the Syrian civil war in 2011. This study compares the number of postoperative complications of patients admitted to the GMC immediately after injury or two to three weeks after initial high-velocity maxillofacial injuries and the potential mechanisms for the variation in complication rates. We describe our experiences, strategies, and resultant treatment approach.Methods: Retrospective case studies in which the incidence of complications including infection, rejection of hardware, bone or soft tissue grafts, tissue dehiscence, oroantral fistula formation, excessive scarring, and unplanned return to the operating theater were investigated. Patients arriving at the GMC within 24 hours following maxillofacial injury were considered “early” while patients arriving to the GMC within 14-28 days following initial trauma without treatment prior to arrival were considered “late” or “delayed.” Both groups of patients received definitive surgical treatment within 48 hours of admission to our hospital. Results: Sixty patients suffering from "high-velocity" maxillofacial Syrian civil war-related battlefield injuries were included in this study. The mean age was 26±8 years (range: 9-50) and all except one were male. Post-operative complications in the early group were found to be significantly higher compared to the delayed group (p = 0.006).Conclusions: We discovered that the delayed group of patients, characterized by progressive neovascularization of injured tissue, had better surgical success from rich blood supply that enhances tissue survival. Sustained tissue perfusion to the tissue supports efficient systemic antibiotic delivery, a favorable condition in lowering infection rate and complication. We found that the unintendedly delayed treatment contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications.

scholarly journals The impact of delayed surgical intervention following high velocity maxillofacial injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniel Oren ◽  
Amiel A. Dror ◽  
Adeeb Zoabi ◽  
Adi Kasem ◽  
Lior Tzadok ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
High Velocity ◽  
Medical Center ◽  
Complication Rates ◽  
Maxillofacial Injuries ◽  
Delayed Treatment ◽  
Syrian Civil War ◽  
The Mean ◽  
The Impact

AbstractOur study compares the number of postoperative complications of Syrian patients admitted to the Galilee Medical Center (GMC) over a 5-year period (May 2013–May 2018) for treatment after initial high-velocity maxillofacial injuries sustained during the Syrian civil war. Specifically, we evaluated complication rates of patients arriving “early,” within 24 h, to the GMC versus those who arrived “late,” or 14–28 days following high-velocity maxillofacial injuries. Both groups of patients received definitive surgical treatment within 48 h of admission to our hospital with a total of 60 patients included in this study. The mean age was 26 ± 8 years (range: 9–50) and all except one were male. Postoperative complications in the early group were found to be significantly higher compared to the delayed arrival group (p = 0.006). We found that unintentionally delayed treatment may have contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications. We discuss potential mechanisms for complication rate variations, including critical vascularization periods. Our study may add to a growing body of work demonstrating the potential benefit of delayed surgical treatment for high-velocity maxillofacial injuries.

Innocent Children in the Syrian Civil War

2019 ◽  
Vol 30 (02) ◽  
pp. 215-219
Author(s):  
Mehmet Emin Çelikkaya ◽  
Ahmet Atıcı ◽  
Çigdem EL ◽  
Bülent Akçora
Keyword(s):  
Civil War ◽  
Demographic Data ◽  
Mortality And Morbidity ◽  
War Injuries ◽  
Syrian Civil War ◽  
History Of ◽  
The Mean ◽  
War Victims ◽  
Trauma Score ◽  
Type Of Injury

Abstract Introduction Our aim is to present the clinical and surgical characteristics of the children affected by the Syrian civil war. Materials and Methods Medical records were reviewed retrospectively for Syrian war victims between the ages of 0 and 18 who were brought to the emergency department of the Education and Research Hospital between March 2011 and March 2019. Each patient was evaluated with respect to demographic data (gender, age), type of injury, history of operations in Syria, injured organ(s), accompanying traumas and the mortality and trauma score. Results The majority of our study population of 147 patients were male (108/147, 73.46%), and 39 of the total were girls (26.53%). The mean age of the patients was 9 (7.5 ± 4). The mean age of the girls was 8.5 (range: 7 months to 16 years), and the mean age of the boys was 9.2 (4 months to 17 years). Seventeen patients who had abdominal surgery in Syria were operated on again after clinical and radiological observations. A total of 83 patients were operated on in Turkey. For 66 of those patients, the operation in Turkey was their first surgery on their war injuries. Seventeen patients were operated on in Syria but needed surgery again in Turkey. Conclusion War affects not only the battlefield, but also the neighboring countries in many aspects such as medical, social, and economic. Hollow organ injuries are the most common intraabdominal pathologies. Delayed intervention is associated with increase mortality and morbidity.

Refugees’ dehumanization in the Spanish media: A corpus-assisted study within the semantic preference framework

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Gema Alcaraz-Mármol ◽  
Jorge Soto-Almela
Keyword(s):  
Civil War ◽  
Middle East ◽  
Economic Burden ◽  
Digital Libraries ◽  
Armed Conflicts ◽  
Critical Discourse ◽  
Manual Analysis ◽  
Syrian Civil War ◽  
The Media

AbstractThe dehumanization of migrants and refugees in the media has been the object of numerous critical discourse analyses and metaphor-based studies which have primarily dealt with English written news articles. This paper, however, addresses the dehumanizing language which is used to refer to refugees in a 1.8-million-word corpus of Spanish news articles collected from the digital libraries of El Mundo and El País, the two most widely read Spanish newspapers. Our research particularly aims to explore how the dehumanization of the lemma refugiado is constructed through the identification of semantic preferences. It is concerned with synchronic and diachronic aspects, offering results on the evolution of refugees’ dehumanization from 2010 to 2016. The dehumanizing collocates are determined via a corpus-based analysis, followed by a detailed manual analysis conducted in order to label the different collocates of refugiado semantically and classify them into more specific semantic subsets. The results show that the lemma refugiado usually collocates with dehumanizing words that express, by frequency order, quantification, out-of-control phenomenon, objectification, and economic burden. The analysis also demonstrates that the collocates corresponding to these four semantic subsets are unusually frequent in the 2015–16 period, giving rise to seasonal collocates strongly related to the Syrian civil war and other Middle-East armed conflicts.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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