PREDICTIVE DEFINITION OF THE SEVERITY OF CLOSED CHEST AND ABDOMINAL TRAUMA CAUSED BY SHOTS FROM 12-GAUGE "FORT-500" RIFLES WITH SHOCK-TRAUMATIC BULLETS OF "TEREN-12P" CARTRIDGES

Objective – the predictive definition of the severity of closed chest and abdominal traumaaccording to the reduced AIS injury scale when firing at various distances from "Fort-500" rifles with shock-traumatic bullets of "Teren-12P" cartridges, depending on theirballistic and energetic characteristics in contact with the human body.Material and methods. To establish the speed of bullets of cartridges "Teren-12P" atvarious distances of the shot in the conditions of KhNSC «Hon. Prof. M. S. BokariusForensic Science Institute» experimental shots from the "Fort-500A" and "Fort-500M1"pump-action guns were conducted. In total, two series of 25 shots were fired from eachgun. The values of the velocities of the bullets at the moment of the firing were measuredusing optoelectronic complexes. The determination of the parameters of the trajectory ofthe flight of bullets was carried out by a combined method by means of calculations basedon the results of experimental shots. The obtained data were processed using licensedMicrosoft Excel spreadsheets.Results. According to the research results, it has been found that the ballistic coefficient of the bullet of the "Teren-12P" cartridge is 47.3 kg/m2. This made it possible to determinethe ranges of minimum and maximum speeds of bullets at different shooting distances.Analysis of the data showed that in some cases the speed of bullets at a distance of 3.5m significantly exceeded the speed range declared by the manufacturer of the cartridges.According to the calculated values, according to the literature data, the graphs of thedistribution of the BC blunt injury criterion and the reduced AIS damage scale wereplotted depending on the distance of the shot for the minimum and maximum bullet speedsof the "Teren-12P" cartridges. According to the graphs, when the "Teren-12P" bulletsare fired at their maximum speeds, there is a 50% risk of a closed chest and abdominalinjury according to AIS -2 – AIS-3 at all distances up to 50 m. Even at minimum bulletspeeds cartridges "Teren-12P" there is a 50% risk of formation of a closed abdominaltrauma according to AIS-2 – AIS-3 with shots from a distance of up to 40 m, and chestinjuries – up to 30 m. Closed trauma to these areas of the body according to AIS-4 can bepredictably caused by shots from a distance of up to 10 m.Conclusions. A significant range of variability in the initial speeds of elastic bullets canlead to an incorrect expert estimate of the firing distance due to the fact that similargunshot wounds can be caused by both a bullet with a high initial speed from a longrange of a shot and a bullet with a low initial speed from a close firing distance. Whenthe "Teren-12P" bullets are fired from "Fort-500" rifles, there is a 50 % risk of a closedchest and abdominal injury according to AIS -2 – AIS-3 at all shooting distances up to50 m. Chest and abdominal injuries according to AIS -4 can be predictably caused whenfired from distances up to 10 m. The results obtained can be used in carrying out complexforensic examinations in cases of the use of "Teren-12P" cartridges.

Active extraperitoneal hematoma in the anterior abdominal wall after blunt injury

A 65-year-old male patient had extraperitoneal hematoma of the anterior abdominal wall after blunt trauma. The patient was treated with conservative management because of stable hemodynamics without deterioration of physical examination and laboratory tests; however, computed tomography revealed active bleeding. In abdominal wall hematoma, physical examination, hemodynamic monitoring, and laboratory tests may be the most important factor in determining a therapeutic plan. Repetitive imaging can be obtained and invasive treatment should be considered if these indices suggest hematoma exacerbation. Patients with abdominal trauma who have altered coagulation status should be carefully monitored for abdominal wall hematoma. Detecting abdominal wall hematoma is important because it may be the clue for potential intra-abdominal organ injury or delayed complication.

A Clinical Analysis of the Medicolegal Cases Presented at Khawaja Muhammad Safdar Medical College, Sialkot

Objective: To determine the clinical pattern of the medicolegal cases presented at Khawaja Muhammad Safdar Medical College, Sialkot Material and Methods: It was a retrospective Hospital based cross-sectional study, which was conducted at medicolegal clinic of government Khawaja Muhammad Safdar Medical College, Sialkot. All the cases those, who were presented at emergency department (medicolegal clinic) with history of industrial injuries, Road traffic accidents, burns, Assault, Falls and Poisoning and others with either of age and gender were included. This analysis was of one year from January 2020 to December 2020. All the data was recorded via self-made study proforma and analyzed by using SPSS version 20. Results: A total of 1079 medicolegal incidents were analysed. Out of all blunt injury, sharp weapon injury, poisoning, acid intake and road traffic incidences were found to be commonest as 27.20%, 20.60%, 15.60%, 12.40% and 10.20% respectively. Blunt injuries, sharp weapon injuries, gunshot injuries and alcohol intake incidences were significantly higher among males and poisoning and acid intake incidences were significantly high among females (p-<0.05). Blunt injuries, sharp weapon injuries, alcohol and poisoning events were seen significantly high almost during winter season from January to march (p-0.001). Conclusion: In the study conclusion, blunt injury, sharp weapon injury, poisoning, acid intake and road traffic incidences were observed to be the commonest medicolegal incidences. These events mostly observed during January to March duration. However blunt injuries, sharp weapon injuries, gunshot injuries and alcohol intake incidences were mostly observed among males, while poisoning and acid intake incidences among females. Keywords: Medicolegal events, gender, season

Comperative analysis of accuracy between low-frequency ultrasound biomicroscopy and 14-MHz ultrasonography with tissue harmonic imaging for the evaluation of the posterior lens capsule in traumatic cataracts

Background To compare the accuracy of low-frequency ultrasound biomicroscopy (LFUBM) and 14-MHz ultrasonography with tissue harmonic imaging (14-MHz + THI) in the assessment of posterior capsule (PC) integrity in patients with traumatic cataracts (TCs). Methods From January 2019 to October 2020, 51 patients (51 eyes) with TCs who were scheduled for cataract extraction and for whom the PC of the lens could not be observed by the slit lamp visited Tianjin Eye Hospital, including 47 patients (47 eyes) with a penetrating injury of the eyeball and 4 patients (4 eyes) with a blunt injury of the eyeball. All eyes underwent LFUBM and 14-MHz + THI examinations before cataract extraction to determine the integrity of the PC. The integrity of the PC observed in surgery was the actual findings, and the consistency between the 2 methods was assessed in terms of the preoperative examination and intraoperative findings. Fisher’s exact test was used for consistency analysis, and P < 0.05 was considered statistically significant. Results Thirty-two eyes with ruptured PCs and 19 eyes with intact PCs were actual findings in surgery. Thirty eyes with ruptured PCs and 21 eyes with intact PCs were examined by LFUBM. Thirty-two eyes with ruptured PCs and 19 eyes with intact PCs were examined by 14-MHz + THI. There were no significant differences between the 2 methods and the intraoperative findings (P = 0.293 LFUBM, P = 0.623 14-MHz + THI). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LFUBM and 14-MHz + THI were 91 and 94%, 95 and 89%, 97 and 94%, 86 and 89% and 92 and 92%, respectively. Conclusions Both LFUBM and 14-MHz + THI were proved to have high levels sensitivity and specificity in diagnosing the status of the PC in TC and they can be used as accurate diagnostic tool in these cases.

A Practical Approach to Introducing Pre-Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), the Problems Encountered and Lessons Learned

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an endovascular procedure which utilises a catheter based balloon device to achieve aortic occlusion. The aim of this resuscitative measure is to improve blood pressure proximal to the occlusion site and therefore preserve cardiac and cerebral perfusion in order to prevent cardiac arrest; additionally there is a relative reduction in arterial inflow to the site of injury. Endovascular techniques are gaining acceptance for the in-hospital management of haemorrhage, however their use in pre-hospital care is still limited. This is due to a number of factors including the technical challenges, training and skill sets of pre-hospital care teams and the potential for harm of REBOA, particularly with extended balloon occlusion times. However, non compressible torso haemorrhage is associated with a mortality of approximately 50% and a significant proportion of these deaths occur in the pre-hospital phase of care. In the exsanguinating patient, resuscitative thoracotomy (RT) with direct aortic compression is often the only means to control haemorrhage. This resuscitative measure is now an established pre-hospital intervention which has significantly improved outcomes in the context of penetrating trauma, particularly thoracic injury. In the context of blunt injury and subdiaphragmatic haemorrhage, however, the outcomes from pre-hospital resuscitative thoracotomy remain poor. We present our initial technique for successfully introducing REBOA for the pre-hospital management of exsanguinating pelvic or groin heamorrhage following trauma, our indications for REBOA and comment on the problems and limitations encountered as well the lessons learned.

Intravitreal Ranibizumab for Treatment of Posttraumatic Choroidal Neovascularization: a Case Report

An analysis of the case of applying a course of fibrinolytic therapy and one intravitreal injection of an angiogenesis inhibitor in a patient with traumatic rupture of the choroid complicated by choroidal neovascularization (CNV) is presented. Patient B., 20 years old, complained of a lack of objective vision after a blunt injury to his right eye in March 2018. Visual acuity decreased to 0.01 (ETDRS 0 characters). During the examination revealed: partial hemophthalmus, rupture of the choroid, Berlin retinal opacification. Local fibrinolytic conservative therapy with positive dynamics was carried out in the form of increasing visual acuity to 0.3 (ETDRS 21 characters) and partial resolution of hemophthalmus. According to optical coherence tomography angiography (OCTA), minimally active CNV was detected. Due to the weak activity of the pathological process, a decision was made on dynamic observation. A follow-up examination in August 2018 revealed an increase in CNV activity according to OCTA and fluorescence angiography (FAG), in connection with which intravitreal administration of ranibizumab (lucentis) was performed. Subsequently, the patient was under dynamic observation for one year. Positive dynamics was revealed in the form of an increase in visual acuity, first to 0.7 (ETDRS 48 characters) 3 months after intravitreal injection, and after a year — to 0.9 (ETDRS 55 characters). After treatment according to OCTA and FAG, the activity of CNV was not determined. Despite the favorable result of treatment, further monitoring of the patient is necessary, since the long-term prospects for maintaining the achieved high visual functions remain unclear due to the insufficient experience in treating patients with this pathology according to the literature.