Serious Suicide Attempt by Hunting Gun with Severely Infectious Wounds and Facial Deformity during COVID-19 Arena; A Case Report

The etiology of suicide among students around the world revolves issues such as communication, education, family problems and parents’ relationship. We intend to report a case with serious recurrent suicide attempt by gun shot during COVID-19 period. We also present psychiatric and clinical evaluation, cosmetic surgery consultation, as well as microbial assessments in this survey. The seventeen-year-old single male student from southwest of Iran with asymmetric deformed face was observed with the loss of parts of the mouse, nose, chin and mandible region .He had experienced a serious suicide attempt by a threatening plan following rejection. The patient had blurred, hypo phonic and hypotonic speech. Following the shooting, the soft and hard palate, facial, frontal bone and sinus had been destroyed and a foreign body was seen in the frontal sinus. After suicide risk as assessment, It was detected multiple predictive risk factors for recent suicide attempt and the possibility of recurrent suicide in future. Finally, reconstructive surgery was performed. We assessed him via face to face interview in order to identify psychiatric disorders. Also, he was evaluated as probability of committing recurrent suicide. It is emphasized that in families which young children are prone to psychiatric disorders or emotional problems, availability of a dangerous device such as a gun can be harmful and it should be removed as soon as possible. We suggest the need for psychiatric evaluation especially suicide phenomenon in adolescents and their families as various conflicts in family context.

Modern aspects of diagnosis of the abdominal gun-shot woundings. Experience of a hybrid war in the East of Ukraine

Objective. To raise the efficacy of radiological diagnosis of the gun-shot abdominal woundings, using modern highly informative methods of medical visualization with determination of their sensitivity and specificity. Materials and methods. Retrospective analysis was done of the results of radiological diagnosis, endovideosurgical and invasive interventions under the radiological methods guidance in 70 injured persons with the gun-shot abdominal woundings, to whom a qualified surgical aid with some elements of specialized help was delivered in 2014-2020 yrs. Average age of the injured persons have constituted 30 complete years old. There were 68 (97.1%) men and 2 (2.9%) women. The results of digital roentgenography, ultrasonographic diagnosis, laparoscopy/laparocentesis, thoracoscopy/thoracocentesis, the puncture-draining interventions under the radiological methods guidance in the injured persons with the gun-shot abdominal woundings were compared to results of the multidetector computed tomography with dynamical contrasted enhancement as a “gold standard” of diagnosis of the gun-shot abdominal woundings and criterion of the foreign bodies visualization (metallic shrapnel, bullets, fragments of bone, drains etc.). Results. The main mechanism of damage in the affected persons with the gun-shot abdominal woundings were shrapnel, created as a result of application of various kinds of the gun-shot and explosive weapons. The part of the gun-shot shrapnel woundings statistically significantly prevailed over part of the bullet and explosive woundings. In accordance to the wound channel kind, the part of blind woundings have had prevailed over parts of the through and multiple woundings statistically significantly (p < 0,05). On a mobile tactical level the rate of application of ultrasonic diagnosis and digital roentgenography for primary selection and diagnostic monitoring was statistically significantly (p < 0.05) higher, than of other methods of medical visualization, what may be explained by improvement and optimization of the treatment and diagnosis tactics, application of urgent sonography in trauma and other modified protocols. Optimal diagnostic system was determined in accordance to indices of sensitivity and specificity of the medical visualization methods, endovideosurgical and puncture-draining interventions under the radiological methods of control - the multidetector computed tomography with dynamical contrasted enhancement. Conclusion. High sensitivity (99%) and specificity (98%) of the multidetector computed tomography with dynamical contrasted enhancement permits to apply it as a method of medical visualization of the gun-shot abdominal woundings for diagnostic selection of wounded persons and the diagnosis establishment.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types of microorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in non-traumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injury with air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

LC-MS/MS monitoring for explosives residues and OGSR with diverse ionization temperatures in soil & hands: 30 minutes for extraction + elution

A fast LC-APCI-MS/MS screening/confirmation method was developed and validated for trace analyses of 18 analytes which are explosives and organic gun shot residues including the challenging ones with diverse ionization conditions, in soil and on hands. (+) and (−) ionization modes were used after a single-step, low-volume solvent extraction procedure developed using methanol. Tape-lifting, stub, alcohol wipes, cotton bud were compared for collecting the residues from hands of a shooter. Tape-lifting and stub gave the highest recoveries and tape-lifting was chosen. Gradient elution system using ammonium chloride:methanol was developed. Whole procedure lasted approximately 30 min, was validated in both matrices, applied to real samples as post-blast residues, smokeless powder and the hands of a shooter, after shooting. Most of the recoveries were >80% and since all the precisions were <15%, quantitation was possible for all. Limit of Detection (LOD) and Limit of Quantification (LOQ) values were: 0.2–54.1 and 0.3–190.0 ngg−1 in soil, and 0.2–132.3 and 1.1–355.0 ngg−1 in tape-lift.

Prevalence and Pattern of Open Fractures in Level-II Hospital, Central Africa

Introduction: Open fractures are known orthopaedic emergencies associated with healing problems and risk of infection. The open fractures are common cases because of motor vehicle and motorbike accidents, falls from height and sometimes gun-shot wounds. Significant morbidity and subsequent disability may happen, if not managed properly. Aim: To evaluate the pattern of open fractures associated with healing problems and achieving sound bone union, avoiding infection and regaining full functional recovery of the limb. Methods: This retrospective study included all the patients who were hospitalized with open fractures of lower limbs in a United Nations Level II Hospital of Bangladesh Medical Contingent at Kaga-Bandoro in Central African Republic from April 2015 to November 2018. Results: There were 57 patients with open fractures resulting 17.8% of total trauma patients. The mean age was 31.8±11.6 years. Most patients were in the 20-39 years age group. The male to female sex ratio was 4.2:1. Road traffic accident was the main cause of open fractures (59.6%). Fractures of tibia-fibula and femur contributed 49.1% and 15.7% respectively and 89.4% satisfactory results were achieved after treatment. Conclusion: The management of open fractures presents a challenge due to risk of infection, healing problems and subsequent morbidity. Adequate debridement and copious lavage remains one of the cornerstones of management of open fractures. The initial management of open fractures affects the ultimate outcome. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 50-53

The case of the disappearing bullet: An extraluminal compression of the biliary tree

Penetrating abdominal injuries, especially from gun shot wounds, are a common occurrence in South African hospitals, and a vast majority of these patient receive surgical intervention for suspected intra-abdominal injuries. Not all bullets are found and removed however, and we detail the case of a gentleman who presented to our institution with obstructive jaundice secondary to an extraluminal compression of his biliary tree by a retained migrated bullet, that spontaneously resolved, without any surgical intervention.