17β-Estradiol Abrogates Oxidative Stress and Neuroinflammation after Cortical Stab Wound Injury

Disruptions in brain energy metabolism, oxidative damage, and neuroinflammation are commonly seen in traumatic brain injury (TBI). Microglial activation is the hallmark of neuroinflammation. After brain injury, microglia also act as a double-edged sword with distinctive phenotypic changes. Therefore, therapeutic applications to potentiate microglia towards pro-inflammatory response following brain injury have become the focus of attention in recent years. Here, in the current study, we investigated the hypothesis that 17β-estradiol could rescue the mouse brain against apoptotic cell death and neurodegeneration by suppressing deleterious proinflammatory response probably by abrogating metabolic stress and oxidative damage after brain injury. Male C57BL/6N mice were used to establish a cortical stab wound injury (SWI) model. Immediately after brain injury, the mice were treated with 17β-estradiol (10 mg/kg, once every day via i.p. injection) for one week. Immunoblotting and immunohistochemical analysis was performed to examine the cortical and hippocampal brain regions. For the evaluation of reactive oxygen species (ROS), reduced glutathione (GSH), and oxidized glutathione (GSSG), we used specific kits. Our findings revealed that 17β-estradiol treatment significantly alleviated SWI-induced energy dyshomeostasis and oxidative stress by increasing the activity of phospho-AMPK (Thr172) and by regulating the expression of an antioxidant gene (Nrf2) and cytoprotective enzymes (HO-1 and GSH) to mitigate ROS. Importantly, 17β-estradiol treatment downregulated gliosis and proinflammatory markers (iNOS and CD64) while significantly augmenting an anti-inflammatory response as evidenced by the robust expression of TGF-β and IGF-1 after brain injury. The treatment with 17β-estradiol also reduced inflammatory mediators (Tnf-α, IL-1β, and COX-2) in the injured mouse. Moreover, 17β-estradiol administration rescued p53-associated apoptotic cell death in the SWI model by regulating the expression of Bcl-2 family proteins (Bax and Bcl-2) and caspase-3 activation. Finally, SWI + 17β-estradiol-treated mice illustrated reduced brain lesion volume and enhanced neurotrophic effect and the expression of synaptic proteins. These findings suggest that 17β-estradiol is an effective therapy against the brain secondary injury-induced pathological cascade following trauma, although further studies may be conducted to explore the exact mechanisms.

Peroneal/posterior tibial nerves delayed dysfunction due to traumatic popliteal artery pseudoaneurysm resulting from trivial stab wound: A case report

Background: Popliteal artery pseudoaneurysms due to stab wounds are extremely rate. Even more infrequently, they can contribute to the compression of multiple peripheral nerves. Case Description: A 23-year-old male, following a trivial stab wound, developed the delayed occurrence of a pseudoaneurysm of the popliteal artery. This resulted in the delayed onset of a compressive popliteal/posterior tibial neuropathy. Following restoration of blood flow through the popliteal artery utilizing saphenous vein grafting, additional neurolysis resulted in resolution of the compressive neuropathy. Conclusion: A 23-year-old male developed a pseudoaneurysm following minor trauma that resulted in peripheral nerve dysfunction.

Stab Wound with a Missed Broken Blade near Thoracic Vertebrae

The authors report a case of a 19-year-old man who was stabbed in the thoracic area and the blade of knife was broken deep inside near the spine. The blade was surgically removed without any serious damage to the spinal cord, main vessels, and organs and the patient had no problems after surgery.

Internal Tension Sutures in term of Wound Healing in Patients Undergoing Laparotmy

Objective: The aim of this study is to determine the effectiveness of internal tension sutures in term of wound healing in patients undergoing laparotomy. Study Design: Prospective cross sectional study Place and Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from 15th November 2020 to 15th May 2021. Methods: One hundred and fifty patients of both genders were presented this study. Patients were aged between 20-60 years of age. Patients’ detailed demographics including age, sex and body mass were recorded after taking informed written consent. Internal tension sutures technique were used for laparotomy among patients who had intestinal obstruction, fire arm injury or stab wound to abdomen, intra-abdominal malignancies, pancreatitis. Mean post-operative pain was measured by using VAS. Outcomes in terms of healing and complications were observed at the end of study. Complete date was analyzed by SPSS 27.version. Results: There were 115 (76.7%) patients were males and 35 (23.3%) were females. Mean age of the patients were 39.09±12.24 years with mean BMI 28.17±8.42 kg/m2. Among 150 cases, majority of the patients 120 (80%) were treated as elective and 30 (20%) were treated in emergency. Symptoms among patients were peritonitis, intestinal obstruction, trauma, mesenteric ischemia, intra-abdominal malignancy, pancreatitis and obstructive jaundice found. Effectiveness was found among 140 (93.3%) cases and only 10 (6.7%) adverse outcomes were found i.e. wound infection and incisional hernia. Patients’ satisfaction was 94.7% among all cases. Conclusion: We concluded in this study that use of internal tension sutures technique for laparotomy is an effective and safest technique in terms of less complications and wound infections with excellent outcomes. We observed that majority of the patients were satisfied by this technique. Keywords: Wound dehiscence, Internal tension sutures, Laparotomy, Incisional hernia

Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.