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

RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH PANCREATIC INJURIES

The analysis of 12 cases of surgical treatment of young male patients, with injuries of the pancreas is presented. By the nature of the injuries, half of the patients had gunshot injuries, and 4 had blunt injuries, 2 patients with stab and slash wound. All injuries were combined; with severity grades I–III according to AAST classification. All patients underwent laparoscopic procedures. In one patient distal pancreatectomy was performed, whereas in 7 patients the appropriate sutured closure and in 4 patients drainage closure were performed. In one patient, we used a gastric transplant on a vascular pedicle. This case is of particular interest, so we presented it separately.

Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation. Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.

Arnika górska jako roślina lecznicza

The pharmacological properties of arnica flowers are mainly due to the action of sesquiterpene lactones and flavonoids. The mechanism of the anti-inflammatory action of Arnicae flos (in vitro studies) is based on the inhibition of the release of pro-inflammatory factors: NF-κB, NF-AT and metabolic products of arachidonic acid. This herbal substance is used only externally in blunt injuries (contusions, sprains, bruises), as well as in muscle and rheumatic pains. Strong antimicrobial properties, equal to the activity of antibiotics, justify the use of arnica flowers in dermatoses.

Penetrating and blunt injuries of the heart - an abdominal surgeon’s personal experience in Serbia

Introduction. In the world with constantly increasing incidence of violence and trauma on one side, and more and more specialized surgeons on the other side; question about the role of abdominal surgeons in cardiac trauma emerges. Objective of this article is to show personal experience of an abdominal surgeon in managing heart trauma. Outlines of cases. We showed two penetrating injuries and one blunt trauma of the heart successfully managed by an abdominal surgeon. Conclusion. Abdominal surgeons should feel comfortable with the decision to operate on greatly physiologically deranged patients with penetrating chest trauma, and not to delay the operation with conservative measures or with time consuming transport to remote specialized facilities, since that could lead to greater death percentage of these patients.

Suicide Attempts and Adolescents: The Need for Specialized Resources at Adult Trauma Centers

Background: Suicide is the second leading cause of adolescent death and suicide attempts outnumber deaths 50:1 for adolescents 15 to 19 years of age. This study examines differences in outcomes between adolescents and adults treated at an adult trauma center in an effort to guide recovery and prevention strategies following an adolescent suicide attempt. Methods: Retrospective review of patients aged >14 years treated at an urban, Level 1 trauma center for self-inflicted injuries between 2009 and 2018 was performed. The cohort was divided into adolescents (14-19 years) and adults (>20 years) and into group A (economically distressed) and group B (non-distressed). Demographics, injury, outcomes, and geospatial analysis were compared. Results: Among 723 patients, 60 (8%) were adolescents of which 92% were male, 55% black, 47% blunt injuries, and 53% penetrating. In adults, 76% were male, 41% black, 28% blunt injuries, and 72% penetrating. Mortality estimates for adolescents and adults were 35% and 24%, respectively (p=0.09). Most adolescent deaths occurred within 3 days after admission, while adult deaths occurred further into hospitalization (p<0.01). Cox regression analysis found higher mortality with self-pay compared to private insurance (HR 2.6; p<0.001), and penetrating vs. blunt/other injuries (HR 2.4; p<0.001). Psychiatric care was administered in 64% of adolescents (n=39) and 84% of adults (p< 0.01). Conclusions: Inpatient psychiatric care for adolescents who attempted suicide was limited at an adult trauma center. The high incidence of suicide attempts and community-level distress in adolescents require immediate attention and resources.

Incidence of COVID-19 in random trauma patients at DHQ Teaching Hospital, Rawalpindi, measures to prevent its spread among patients and health care workers

Background: The objective of the study was to see the incidence of COVID-19 positive, in random trauma patients received in the emergency of abdomen or chest may be penetrating or blunt. Materials and Methods: This study was conducted in the Accident and Emergency department of District Head Quarter Hospital, Rawalpindi. All trauma patients of abdomen or chest either penetrating or blunt admitted from 1-3-20 to 10-6-20 were included, irrespective of age, gender, comorbidities, and COVID-19 status at the time of admission to hospital. Also to see steps of preventive measures taken in the emergency department, operation theatres, and inwards. Results: Total number of trauma patients received in the emergency department of District Headquarter Hospital Rawalpindi during this period was 163. Total male patients: 116. Total female patients:47. Penetrating injuries (firearm or stab wounds): 93. Blunt injuries: 70. All the penetrating injuries were operated as an emergency. Among blunt injuries, 51 were operated 19 were treated conservatively. Preoperatively none of the patients’ COVID-19 test was performed because none of them showed any symptoms likely of COVID-19 such as chest infection, flue, malaise, or fever. After the second postoperative day, 12 of the patients developed respiratory distress and their COVID-19 test was sent. Out of 12 patients, 7 turned out to be COVID-19 positive. Other on the second or third postoperative day 7 patients had fever without chest symptoms and underwent COVID-19 testing. 3 turned out to be COVID-19 positive. So a total of 11 patients were found to be positive for COVID-19. The percentage became 6.7% which is quite high. Conclusion: From this study, its clear in acute trauma patients where you can’t go for the COVID-19 test even then we have to operate may be positive. So every trauma patient should have suspected COVID-19 positive and preventive measures should be taken starting from the emergency department till operation theatres.

Single center experience of war-related thoracic injury in Syria

Background: The Syrian civil war caused serious deaths and injuries. Thoracic surgery has shown its effectiveness in this war as it is a war surgery. In this study, we analyzed war related chest trauma patients to describe the profile of chest trauma, determine the predictors’ morbidity and mortality. Methods: From 2012 to 2017, 47 consecutive patients underwent surgical treatment for chest trauma at the Gaziantep University Sahinbey Research and Practice Hospital, in Turkey. The demographic and relevant clinical information were retrospectively collected from the hospital records. Data included mechanism of injury, gender, and age, findings, treatment modality complications, and length of hospital stay, morbidity and mortality. Injuries were classified as penetrating (gunshot or shrapnel wounds) and blunt injuries. Results: The average age of patients was 25.4 years (range, 4 to 43 years) and 40 patients were males (85%). Sadly, 6 patients were under 18 years old. There were 41 patients (%87,2) penetrating and 6 patients (%12,8) blunt injuries. The most penetrating injuries of the chest were caused by shrapnel (61,7%). Eleven patients had already had emergency thoracotomy in another hospital before admission. As multiple diagnoses, there were 50 (45,45%) pneumothorax, hemothorax, or both in patients. However, there were 26 (23,64%) lung contusions in patients. No surgery-related deaths or major morbidity occurred. One patient died 35 days after admission; the causes of death in this patient included bronchobiliary fistula, hypovolemic shock, and sepsis. So, all cases mortality rate was 2,13%. Conclusion : Intervention in thoracic trauma patients is life-saving and satisfying compared to other system injuries. War surgery is a multidisciplinary approach, which is vital.