Neuroprotective Potential of Bacopa monnieri: Modulation of Inflammatory Signals

Background: To date, much evidence has shown theincreased interest in natural molecules and traditional herbal medicine as alternative bioactive compounds to fight many inflammatory conditions, both in relation to immunomodulation and in terms of their wound healing potential. Bacopa monnieri is a herb that is used in the Ayurvedic medicine tradition for its anti-inflammatory activity. Objective: In this study, we evaluate the anti-inflammatory and regenerative properties of the Bacopa monnieri extract (BME) in vitro model of neuroinflammation. Methods: Neuronal SH-SY5Y cells were stimulated with TNF and IFN and used to evaluate the effect of BME on cell viability, cytotoxicity, cytokine gene expression, and healing rate. Results: Our results showed that BME protects against the Okadaic acid-induced cytotoxicity in SH-SY5Y cells. Moreover, in TNF and IFN primed cells, BME reduces IL-1, IL-6, COX-2, and iNOS, mitigates the mechanical trauma injury-induced damage, and accelerates the healing of wounds. Conclusion: This study indicates that BME might become a promising candidate for the treatment of neuroinflammation.

Litrature Review Trauma Vascular

Vascular traumatic is trauma to the blood vessels caused by blunt injuries such as a hard impact or penetrating injuries such as sharp object injuries, penetrating bullet shots. Massive haemorrhage is the main cause of vascular trauma, resulting in death. Therefore, prompt treatment is needed to avoid other complications or even death due to uncontrolled bleeding. Vascular surgeons are the key to trauma injury patients, by controlling bleeding and vascular reconstruction, using aspects of open and endovascular surgical techniques. Diagnostic protocols are needed to identify injuries and consider the best tactics for surgical treatment of vascular injuries. Accurate, non-invasive diagnostic imaging techniques are key to this strategy. The aim of this review is to determine the optimal diagnostic imaging in patients with suspected vascular injury in the anatomic region and the method of treatment with retrospective or prospective data collection which is preferable to CT angiography compared to other methods. CT angiography can be declared the gold standard for diagnosing vascular injury in patients.

Location of Injury and Other Factors Associated With Increased Survival Among Severely Injured Geriatric Trauma Patients

Background Patients with a Trauma Injury Severity Score (TRISS) < .5 are termed “unexpected survivors.” There is scarce information published on this subset of geriatric patients whose survival is an anomaly. Methods This is a retrospective case-control study examining all geriatric patients (age ≥65) not expected to survive (TRISS<.5) in the Pennsylvania Trauma Outcome Study (PTOS) database from 2013 to 2017. Primary outcome was survival to discharge. We selected 10 clinically important variables for logistic regression analysis as possible factors that may improve survival. Results 1336 patients were included, 395 (29.6%) were unexpected survivors. Factors that improved survival odds are the following: Place of injury: street/highway (AOR:0.51; 95% CI: .36-.73, P < .001) and residential institution (AOR:0.46; 95% CI: .21-.98, P = .043); and presence of Benzodiazepines (AOR:0.49; 95% CI: .31-.77, P = .002) or ethanol (AOR:0.57; 95% CI: .34-.97, P = .040). Factors that decreased survival odds are the following: Hypotension (AOR: 8.59; 95% CI: 4.33-17.01, P < .001) and hypothermia (AOR: 1.58; 95% CI: 1.10-2.28, P = .014). Gender, race/ethnicity, blood transfusion in first 24 hours, shift of presentation to Emergency Department, place of injury (farm, industrial, recreational, or public building), use of Tetrahydrocannabinol, amphetamines or opioids, and level of trauma activation did not impact survival. Discussion Location of injury (street/highway and residential institution) and ethanol or benzodiazepine use led to a significant increased survival in severely injured geriatric patients. Hypotension and hypothermia led to decreased survival. Future studies should determine possible reasons these factors lead to survival (and identify additional factors) to focus efforts in these areas to improve outcomes in geriatric trauma.

TRAUMATISMO TORÁCICO: ANÁLISIS DE HOSPITALIZACIONES SEGÚN GRUPO ETARIO

Introducción: El traumatismo es la primera causa de muerte en adolescentes y la quinta en el adulto mayor. El traumatismo torácico (TT) posee características particulares en diferentes grupos de edad.Objetivo: Analizar características clínicas, índice de gravedad de traumatismo (IGT) y mortalidad en hospitalizados por TT según grupo etario.Materiales y Método: Estudio analítico de hospitalizaciones por TT, período enero-1981 a diciembre-2018. Revisión de protocolos prospectivos de TT y base de datos. Se definió grupo etario según Organización Mundial de la Salud (Adolescente: 10-19 años; Adulto Joven: 20-44 años; Adulto Maduro 45-59 años; Adulto Mayor: >60 años). Se comparó clasificación, mecanismo, agente, tratamiento, IGT, Trauma Injury Severity Score (TRISS) y mortalidad del TT según grupo etario. Se utilizó SPSS25® con pruebas chi-cuadrado y ANOVA, considerando significativo p<0,05.Resultados: Total 4.297 TT. Grupo etario Adolescente: 608 (14,1%); Adulto Joven: 2.544 (59,2%); Adulto Maduro: 601 (14,0%); Adulto Mayor: 544 (12,7%). Se observó disminución progresiva y significativa en TT penetrante, por agresión y del TT por arma blanca desde grupo etario Adolescente hasta Adulto Mayor. En Adulto Joven predominó tratamiento invasivo: cirugía 541 (21,2%) y en Adulto Maduro el TT con lesiones asociadas 215 (35,8%), p<0,05. Según grupo etario, se observaron diferencias significativas en TRISS y en mortalidad. La mortalidad fue 1,6%; 2,5%; 3,3%; 5,0%, según grupo etario respectivamente (p<0,05).Conclusiones: Existen diferencias estadísticamente significativas en las características clínicas, IGT y mortalidad del TT al comparar distintos grupos etarios. La edad es uno de los factores que determina el pronóstico de pacientes hospitalizados por TT.

Generalized Joint Hypermobility: A Review

Generalized Joint Hypermobility (GJH) is a condition where most of an individual’s synovial joints are found to have a range of motion (ROM) beyond their normal limits. Like most human traits, joint hypermobility is multifactorial resulting from a combination of environmental factors (eg. age, trauma, injury, conditioning, infection, inflammation) and multiple genetic factors, each contributing a small amount to the total phenotype. Clinical features of JHS are mainly associated to the connective tissue and can either be articular or extra-articular. The Beighton 9-point scoring system – also referred to as the modified or revised Beighton score – is a widely accepted method used to define GJH. Management of Generalized Joint Hypermobility is multidisciplinary which requires a team of physicians, physiotherapists, occupational therapists and podiatrists, among others. Physical therapy rehabilitation comprising of core stabilizing, joint stabilizing, strengthening and proprioception enhancing exercise coupled with general fitness program form the basis of GJH management. Keywords: Generalized Joint Hypermobility, Beighton Score, Joint Hypermobility.

A PROSPECTIVE STUDY OF TRAUMATIC BRAIN INJURY (TBI) AT TERTIARY CARE CENTER

Background: Worldwide, traumatic brain injury (TBI) is the single largest cause of death and disability following injury. Most TBI’s are due to road side accidents. According to WHO data, by the year 2020, head trauma will be third largest killer in the developing world. Methods: The present study was conducted in Department of Neurosurgery. The study group consisted of a total of 200 head injury patients presenting to the Trauma center and admitted in neurosurgery ward. Results: Out of 200 cases maximum case(40.00%) were from 21-30 year age group and minimum case(3.00%) were from 0-10 year age group. 81.00% were male and 19.00% were female. Only 21.00% patients managed by surgical treatment. Conclusion: The lack of awareness among the pedestrians and disregard for traffic rules by the motorists were important reasons for most of the accidents. Keywords: Neurosurgery, Trauma, Injury.

Design and Development of a Hemorrhagic Trauma Simulator for Lower Limbs: A Pilot Study

One of the main preventable leading causes of death after a trauma injury is the hemorrhagic shock. Therefore, it is extremely important to learn how to control hemorrhages. In this paper, a hemorrhagic trauma simulator for lower limb has been developed and a pilot study has been accomplished to trail the simulator. Four different bleeding scenarios have been tested per participant, gathering information about the manual pressure exerted to control the bleeding. Data, altogether, from 54 hemorrhagic scenarios managed by final year medical students and doctors were gathered. Additionally, a post-simulation questionnaire, related to the usability of the simulator, was completed. All the participants managed to control the simulated bleeding scenarios, but the pressure exerted to control the four different scenarios is different depending if the trainee is a student or a doctor, especially in deep venous hemorrhages. This research has highlighted the different approach to bleeding control treatment between medical students and doctors. Moreover, this pilot study demonstrated the need to deliver a more effective trauma treatment teaching for hemorrhagic lesions and that hemorrhagic trauma simulators can be used to train and evaluate different scenarios.