Development of mine-blast trauma severity score for lower extremities in men

This study presented the results of the analysis of existing approaches to the assessment of the severity of lower extremity injuries protected with explosion-proof shoes in case of mine-explosive ammunition explosion. An increasing number of mine explosives are used in modern local wars and armed conflicts. At present, more than 110 million mines are planted and activated. Every year, nearly 10 thousand individuals are killed by explosive demolitions, and more than 20 thousand civilians sustain injuries. The necessity to clear minefields and to destroy located ammunition increases the risks of mine clearance specialists to mine-blast trauma of the lower extremities. To reduce the likelihood of severe trauma in this population, developing effective blast protective equipment, such as anti-mine boots, is necessary. The effectiveness evaluation of protective boots requires special methodology that should comprise relevant methods of mine-blast trauma severity estimation. Mine-blast trauma is a special type of surgical pathology where the injured individual has extremity avulsion or multiple injuries to extremity tissues accompanied by severe impairment of body functions. Almost all available domestic classifications of mine-explosive wounds have a pronounced clinical orientation, and foreign ones have terminologies that are not accepted in Russia and cannot be fully used for assessment purposes. The modified working classification, in the form of a rating scale, showed not only the characteristics of a given blast trauma but also the criteria of trauma severity estimation and feasibility of exposure to blast trauma. The results of the study demonstrated the potential for its use to estimate the protective features of mine clearance specialist boots when exposed to charge explosion, as well as recommendations to include this classification in documenting the science and technology that deal with the general specifications of protective equipment for specialists at the project stage.

HEARING LOSS IN BLAST TRAUMA VICTIMS. A MULTICENTRE RETROSPECTIVE STUDY

Objective: To describe the resultant Otologic morbidity and report on the early outcomes following blasts occurring in twin cities of Quetta and Peshawar. Study Design: Case series. Place and Duration of Study: ENT department Tertiary Care Centre Quetta and Tertiary Care Hospital Peshawar. Study period was, from Jan 2013 to Dec 2013. Methodology: All bomb blast patients brought to the hospitals were included in study. Participants completed Symptom Assessment Forms followed by detailed ENT examination and Pure Tone Audiograms on arrival and after 6 weeks. Results: A total of 504 patients were included initially of which 80% of the patients were male. About 57.8% of the patients complained of ear injury, 21.6% of the total patients had tympanic membrane perforation on initial presentation. Chances of spontaneous closure of perforation were 20.9% in our study. Chances of hearing improvement were 17.9% in our study at the end of the study period. Conclusion: Blast related otologic injuries constituted a major source of morbidity The most common type of hearing loss following a blast trauma was mild to moderate conductive type. Chances of recovery of hearing following blast do exist (17.9%). Suspected patients should be regularly assessed and followed up. Much work needs to be done to study the impact of blast trauma on hearing in our country.

In Vivo Cochlear imaging provides a tool to study endolymphatic hydrops

Exposure to noise trauma, such as that from improvised explosive devices, can lead to sensorineural hearing loss and a reduced quality of life. In order to elucidate the mechanisms underlying noise-induced hearing loss, we have adapted optical coherence tomography (OCT) for real-time cochlear visualization in live mice after blast exposure. We demonstrated that endolymphatic hydrops develops following blast injury, and that this phenomenon may be associated with glutamate excitotoxicity and cochlear synaptopathy. Additionally, osmotic stabilization of endolymphatic hydrops partially rescues cochlear synapses after blast trauma. OCT is thus a valuable research tool for investigating the mechanisms underlying acoustic trauma and dynamic changes in endolymph volume. It may also help with the diagnosis and treatment of human hearing loss and/or vertigo in the near future.

The severity degree estimation for the lower extremity blast injury

The present review is concerned with the modern state of the problem connected with the severity degree estimation of the lower extremity blast injury. The specific character of modern combat activity is considered to be the prevalence of the blast trauma in the structure of casualties, this trauma amounting up to 69% of all the combat injuries. The problem of the adequate unbiased estimation of the severity degree for this kind of trauma appears to be critical, because it is important for the appraisal of the necessary volume of medical care provided for the casualties and optimal assignment of the casualties to the medical evacuation stages beginning from the combat zone up to the specialized trauma center. The combat blast trauma is distinguished from the civilian trauma, it also differs from blast injuries occurring during technological disasters. In this regard, the use of traditional estimation parameters for the lower extremity trauma severity, based on clinical findings of civilian injuries, seems not possible. The development of appropriate severity estimation technique for the lower extremity blast trauma is essential not only for the medical care, but also for the adequate experimental modeling processes using human cadavers and biomorphic models, and the development of virtual “mathematical” simulators. Currently, investigators are involved in developing specific severity degree estimation scales for the lower extremity blast injury, based on the case histories analysis and casualties’ follow-up. Foreign experts have proposed a number of assessment classifications of mine-explosive injury, allowing to formulate a diagnosis and determine the severity of the injured explosive limb injuries. In our country, there is currently no generally accepted classification developed in relation to the explosive injury of the lower extremities, but the methods proposed by domestic military field surgeons and traumatologists allow us to effectively assess the severity of this injury and make a certain sorting decision.