Use of potentially driver-impairing drugs among older drivers

Background Road safety is a major issue among seniors. Potentially Driver-Impairing (PDI) drugs are known to increase the risk of car accident. The aim of this cross-sectional study was to describe PDI-drug consumption among older drivers and determine associated factors. Methods The S.AGES cohort is a French non-interventional real-life prospective study of 3700 community-dwelling participants aged ≥65 years old, suffering from type 2 diabetes (T2DM), chronic pain or atrial fibrillation (AF). Baseline data of drivers with known treatment (n = 1783) were used for the analyses. PDI drugs were defined according to the French classification. Results One thousand seven hundred eighty-three drivers were included (66% males; mean age 76 (Standard deviation = 5.78) years old). 21% (n = 373) took PDI drugs, 64% of which took only one (n = 239). The most frequent PDI drugs were: Zolpidem (11%; n = 60); Zopiclone (8%; n = 45); Bromazepam (8%; n = 44); Tramadol (7%; n = 39); Pregabalin (6%; n = 31). Drivers taking PDI drugs had more often chronic pain (OR [95% CI] = 2.30 [1.54–3.46]), history of depressive disorder (4.28 [3.00–6.14]) and polypharmacy (taking at least 5 different medications; 4.32 [2.97–6.41]), and less often T2DM (0.54 [0.37–0.79]), and AF (0.48 [0.32–0.71]). Conversely, they had a lower Activities of Daily Living score (0.34 [0.17–0.68]). Conclusions The rate of aged drivers in the S.AGES cohort taking PDI drugs is concerning and highlights the need to carefully assess and reassess PDI-drug prescriptions in this population, particularly hypnotics, anxiolytics and opioids. Trial registration ClinicalTrials.gov NCT01065909 (First posted: February 9th, 2010).

Blunt Trauma Associated With Bilateral Diaphragmatic Rupture: A Case Report

Background: A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma.Case Presentation: We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital.Conclusions: Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons.

Transarterial embolization for traumatic splenic injury in a patient with a variant origin of splenic artery from the proper hepatic artery

A 57-year-old male patient was diagnosed with grade 2 spleen laceration and other multiple organ injuries after a rollover car accident. The patient was hemodynamically stable. Thus, transarterial embolization was performed to the splenic artery (SA). In angiography, the patient’s SA arised from a proper hepatic artery. The embolization finished successfully and the patient was discharged from the hospital on day 12 without any complications. Transarterial SA embolization may be feasible in patients who have varying SA origins even though the procedure is technically more challenging and a longer catheter may be needed compared to those of the usual case.

Accidental identification of peritoneal encapsulation during an autopsy after a car accident

Peritoneal encapsulation is a rare congenital pathological condition. Typical of this pathology is the presence of an accessory peritoneal flap that encloses the entire mass of the small intestine. Subjects with this condition often do not show symptoms and, in most cases, finding of it is accidental. We report a case of peritoneal encapsulation, not previously identified and found during an autopsy; the deceased, positive for HIV and affected by a Kaposi’s sarcoma, died following a road accident. Unlike other cases in the literature, the peritoneum encapsulated all abdominal organs and not only small intestines. Notwithstanding, there were no signs of intestinal ischaemia or intestinal obstruction.

Solar Retinopathy: Case Report

Aims: To describe a solar retinopathy. Presentation of Case: ALPN, 29 years old, male, with cognitive deficit that started after a car accident that occurred at the age of 6 years, attends the ophthalmology clinic of the University Hospital Antônio Pedro, Rio de Janeiro, Brazil with complaints of decreased visual acuity and metamorphopsia in both eyes (AO) started approximately 8 months ago. Family members reported that after the accident, the patient had the habit of spending mornings and afternoons looking at the sun. Discussion: Solar retinopathy is caused by the photochemical and thermal effects of ultraviolet radiation on retinal cells, especially in the outer retina and retinal pigment epithelium (RPE). Symptoms can start a few hours after direct observation of the sun, and in most cases a bilateral involvement, although asymmetrically with variable visual acuity. Conclusions: A Solar retinopathy has a multifactorial origin, as it is related to the exposure time and the susceptibility of each individual. The use of hats and sunglasses with protection against ultraviolet rays and anti-reflection are effective preventive measures to be adopted if there is a need for exposure and observation of sunlight.

Legal Judgment Prediction Based on Machine Learning: Predicting the Discretionary Damages of Mental Suffering in Fatal Car Accident Cases

The discretionary damage of mental suffering in fatal car accident cases in Taiwan is subjective, uncertain, and unpredictable; thus, plaintiffs, defendants, and their lawyers find it difficult to judge whether spending much of their money and time on the lawsuit is worthwhile and which legal factors judges will consider important and dominant when they are assessing the mental suffering damages. To address these problems, we propose k-nearest neighbor, classification and regression trees, and random forests as learning algorithms for regression to build optimal predictive models. In addition, we reveal the importance ranking of legal factors by permutation feature importance. The experimental results show that the random forest model outperformed the other models and achieved good performance, and “the mental suffering damages that plaintiff claims” and “the age of the victim” play important roles in assessments of mental suffering damages in fatal car accident cases in Taiwan. Therefore, litigants and their lawyers can predict the discretionary damages of mental suffering in advance and wisely decide whether they should litigate or not, and then they can focus on the crucial legal factors and develop the best litigation strategy.

Simultaneous repair of the skull base and the frontal lobe defect using CAD-CAM technology

Many patients with traumatic brain injury develop complications in the postoperative period. The article describes a case of revision surgery in a female patient with cerebrospinal fluid rhinorrhea following a severe car accident. During one surgery, the skull base and the frontal bone defect were repaired and a lumboperitoneal shunt was placed. The skull base was repaired using an autologous musculoaponeurotic graft. For a better cosmetic effect, the implant was designed using CADCAM technologies. The patient had a relapse of the leak in the postoperative period, which required revision surgery (multilayer reconstruction using a fibrin-thrombin sponge). The patient was followed up for 2 years, with no relapse. The desired clinical and cosmetic effects were successfully achieved.

Assessment of Mortality Pattern Based on Autopsy in Victims of Road Traffic Accident

Background: The Trauma and road accident is considered as major cause mortality in the young adults’ populations around the world. The understanding the importance of forensic investigation of un-natural deaths, accidental injuries and suicidal cases is required by medical staff and patients’ family members. Objective: To asses of mortality pattern based on autopsy in victims of road traffic accident Study Design: Retrospective study Place and Duration of the Study: Medicolegal Section of Liaquat University Hospital Hyderabad, Pakistan from 1st January 2018 to 31st December 2019. Methodology: Six hundred and twenty nine autopsies were included. Deaths due to road traffic accident were included. Results: There were 472 males and 157 females between 31 to 50 years. Two hundred and forty nine patients were admitted in ICU. Two hundred and fourteen patients had affected head region followed by face 104 injuries. While 74 had affected neck, 67 affected thorax, 63 affected abdominal region, 52 affected spine and 55 had affected lower extremities.173 were died due to damage of central nervous system. The damages were due to car accident was 62, motorbike 73, rickshaw 22 and other reasons 14. One hundred and forty patients were died due to fracture of skull. Conclusion: The mortalities rates are under reported in majority of accidental cases due to lacking of autopsies procedures. Keywords: Autopsy, Assessment, Mortality pattern, Road traffic accident