Death due to road traffic accident (RTA) was one of the leading causes of mortality and morbidity in India. In the present cross-sectional study, only the victim using two-wheelers, four-wheelers, and pedestrians were included for comparison to determine the pattern of injuries in these victims of the road traffic accident. There was a predominance of males in all three types of victims of RTA with a peak age of incidence seen in 21-30 years in two-wheeler victims, 41-50 years in four-wheeler victims, and 51-60 years in pedestrian victims. Four-wheeler (HMV/LMV) was the commonest type of offending vehicle involved in all types of victims with collision/ dash as the commonest manner of an accident. Head was the commonest region involved in pedestrian and two-wheeler victims as compared to the thorax in four-wheeler victims of accidents. Abrasion was the commonest surface injury in two-wheeler victims and pedestrians. The laceration was more common in two-wheeler victims as compared to crushed injury in pedestrian victims of road traffic accidents. The brain was the commonest organ involved in two-wheeler and pedestrian as compared to lungs in four-wheeler victims. The liver and spleen were more commonly involved in two-wheeler victims as compared to kidneys and bladder in pedestrian.

Inflammation is a complex biological reaction induced by the alteration of tissue homeostasis, which occurs in response to the presence of a biological, chemical or physical agent in the body [1]. The acute inflammatory response is composed of an elaborate cascade of both proinflammatory and anti-inflammatory mediators, and balance between these mediators often determines the outcome after injury [2]. Generally during acute inflammation, cellular and molecular events and interactions reduce the risk of eventual injuries or infections. However, acute inflammation can become chronic, contributing to a variety of chronic inflammatory diseases [3]. Major micro circulatory events that occur during the inflammatory process include changes in vascular permeability, leukocyte recruitment and accumulation, and inflammatory mediator’s release [4]. 

A 53-year-old male presented to the Emergency Department (ED) with multisystem trauma and respiratory distress following a blunt-force injury to his anterior left neck. CT imaging showed extensive subcutaneous emphysema and pneumomediastinum. A chest X-ray showed elevation of the left hemidiaphragm suggesting phrenic nerve injury which was confirmed by bedside ultrasonographic examination of the left hemidiaphragm. Flexible bronchoscopy demonstrated tracheal rupture. The patient was treated supportively and recovered without surgical treatment. Trauma-induced hemidiaphragmatic paralysis is rarely reported. This case represents a clinical scenario with demonstrable anatomic correlations, and a clinical reminder that phrenic nerve injury should be included in the differential diagnosis of respiratory distress in a trauma patient.

Introduction: The tracheobronchial injuries are usually fatal and some of the lucky people can reach emergency services without dying in the place of trauma. They can cause severe symptoms which can be lifetreathing. This type of injuries must been taken carefully and need to decide fast what treatment you going to give. Case report: We present a 53 years old patient who has been stabbed during a fight and got his trachea ruptured. His complaints shortness of breath and neck swelling. He can be treated conservatively with bronchoscopic and clinical evaluation. Discussion: Tracheobronchial injuries are life-threatening and the airway must be secured first. They can be treated conservatively in some cases. CT can be useful but fiberoptic bronchoscopy is the key in diagnosis. Conclusion: Although early treatment of tracheal lacerations is urgent surgery, it is reported that these injuries can be treated with conservative methods under appropriate conditions.

Introduction: Arachnoid cyst (AC) is a congenital, benign, extra-axial lesion often found incidentally on intracranial imaging and makes up almost 1% of all intracranial masses. It arises from the splitting of arachnoid membranes with components similar to the cerebrospinal fluid. It’s reported that AC can be complicated by chronic subdural haematoma in athletes with repeated head injuries. Case report: we describe a case of a soccer player with an AC that underwent surgery for a chronic subdural haematoma with full recovery. Material and method: From a PubMed research, we found 14 relevant studies reporting a total of 15 patients who met the inclusion criteria: playing soccer, subdural hematoma and arachnoid cyst. Results: Patients underwent different surgical treatment. In the case of hygroma with no midline shift, a conservative treatment was performed. In all cases the reported follow up was a full recovery. Discussion: Soccer is not usually considered a contact sport related to a high risk of head trauma or shaking head. From our review we can postulate that a soccer player with AC has an augmented risk to have a subdural haemorrhage, more rarely intracerebral haemorrhage. Conclusion: ACs are common meningeal abnormalities. They may bleed after minor head trauma, although it is rare. Asymptomatic patients with known AC should be monitored by a neurosurgeon and decision to engage this patient in soccer sport participation is still controversial.

Avulsive injuries to the face can be challenging. Soft tissue defects secondary to trauma and bites nessecitate local tissue transfer and the tissue closely resembles the missing skin in color and texture. These flaps can be rotated, advanced or transposed into a tissue defect and include: The forehead flap (median, paramedian) for large nasal defects.

Burns injuries induce a state of immunodepression that predisposes to a bacterial infectious complication that leads to several comorbid diseases and high mortality rate. Previous studies about anti-inflammatory, antimicrobial and antioxidant properties of Aloe vera (L.) Burm., Calendula officinalis L.and Matricaria recutita L. are acknowledge by antimicrobial effects. Previous studies about anti-inflammatory, antimicrobial and antioxidant properties of Aloe vera (L.) Burm., Calendula officinalis L. and Matricaria recutita L. are knowledge by antimicrobial effects. Bacterial cellulose membrane (nature BCM) is a potential carrier as a drug delivery system in the wound and burn treatment. The present study aimed to evaluate the antibacterial activity of extracts of A. vera, C. officinalis, and M. recutita incorporated in BCM against bacterial strains commonly present in wound and burns. The agar-dilution susceptibility testing was used to determine the minimum inhibitory concentration (MIC) for S. aureus, E. coli, and P. aeruginosa. The standardized extracts of A. vera, M. recutita, and C. officinalis were, respectively, used at 3.25% of total polysaccharides, 1% of apigenin 7-O-glucoside and 0.084% of total flavonoids expressed in quercetin. The BCM incorporated with A. vera extract was efficient to prevent the growth of P. aeruginosa and S. aureus. BCM loaded with C. officinalis inhibited the growth of S. aureus. The BCM loaded with A. vera and C. officinalis extract showed better antibacterial activities against P. aeruginosa and S. aureus and, consequently, properties to prevent infectious disease in the wound or burn caused by these bacteria.

Background: Post exposure chemoprophylaxis can prevent human immunodeficiency virus (HIV) infection in risk healthcare workers; however routine adoptions of these practices by the workers have been limited. Objective: To assess knowledge and attitude of health workers on HIV post-exposure prophylaxis and exposure to sharp injuries in Dessie referral hospital. Methods: Across-sectional study was conducted on 422 health care workers of Dessie referral Hospital. The study subjects were selected by proportional allocation of each sample in its respective department/ward. Simple random sampling method was used to select study participants. The data was cleaned coded and analyzed by using statistical package for social sciences (SPSS) version 23. Finally the result was presented by graphs, pie chart and statements. Results: A total of 422 study subjects were participated in the study. Among 422 participants 72.5% had good knowledge of post exposure prophylaxis for HIV and the rest 27.5% had poor knowledge of post exposure prophylaxis for HIV. Among 422 study participants 75.2% had positive attitude towards PEP. 283(67.1%) of them had exposure to sharp injuries. Conclusion: Generally most of health care workers had good knowledge about post exposure prophylaxis against HIV/AIDS. This study had shown that a significant number of individuals had a negative attitude with regard to post exposure prophylaxis. Therefore, formal training that aims to improve attitudes and support to improve PEP implementation and completion are needed. 

State Department had evacuated a number of Americans from the U.S. consulate in Guangzhou, China after they experienced unexplained health issues. A group of U.S. diplomats stationed in China have been brought back to the states after being inflicted by a mystery illness that reportedly resembles the brain injuries previously suffered by staff in Cuba. At the end of the December 2018 we have found a medicine fully treating the damages caused the Frey Effect of Microwave and other types of Sonic Weapons in Human’s internal, endogenous organs. I am proposing to use Naphasoline nitrate, (former) nasal decongestant, to treat Carcinogenesis of the Human’s internal, endogenous organs caused by Sonic Weapons through the release and cleaning of the Lymphatic ways in patients with colorectal, colon, pancreatic, breast, etc., cancer. I have proved this healing effect of the Naphazoline nitrate on myself during treatment in last months of the year 2018.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health and mental wellbeing by decreasing quality of life. It affects nearly 10 million people and more and more cases are diagnosed because of the advancement seen in movement disorder clinics and diagnostic tools worldwide. Individuals with PD also complain about anxiety arising out of these symptoms of postural instability, low back pain etc., which may lead to increased risk of falls and fall related injuries of brain, bone or other organ systems. Stress is one factor which has been shown to directly correlate to neurodegenerative pathology. Ways to reduce stress at a given point of time and across one’s life span is considered to be a prime necessity in today’s world. Various body-mind exercises like yoga, tai chi, qi gong, tango, ballet etc., has been in research for quite some time now, which has shown benefits in PD patients. In this article evidences related to yoga and its role in PD will be reviewed in a detailed fashion.

Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) [12], metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].  Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness. 

Delayed cerebral ischemia (DCI) is one of the main complications of spontaneous subarachnoid haemorrhage and one of its causes is the cortical spreading depolarizations (CSDs). Cortical spreading depolarizations are waves of neuronal and glial depolarizations in which there is loss of neuronal ionic homeostasis with potassium efflux and sodium and calcium influx. In damaged brain areas and brain areas at risk, such as those adjacent to subarachnoid haemorrhage (SAH), CSDs induce microvascular vasoconstriction and, therefore, hypoperfusion and spread of ischemia. Several studies have been devoted to minimize secondary injuries that occur hours to days after an acute insult. Ketamine, a drug until recently contraindicated in the neurosurgical population for potentially causing intracranial hypertension, has re-emerged as a potential neuroprotective agent due to its pharmacodynamic effects at the cellular level. These effects include anti-inflammatory mechanisms, and those of microthrombosis and cell apoptosis controls, and of modulation of brain excitotoxicity and CSDs. A literature review was performed at PubMed covering the period from 2002 to 2019. Retrospective studies confirmed the effects of ketamine on the control of CSDs and, consequently, of DCI in patients with SAH, but did not show improvement in clinical outcome. The influence of ketamine on the occurrence/development of DCI needs to be further confirmed in prospective randomized studies

Injuries at the elbow are fairly common. Fractures require the immediate attention of the skills of a surgeon. As the fracture heals and motion at the fracture is permissible, the physical therapist can provide important treatment to help the patient gain range of motion, strength, and function.

Cerebral brain injuries (CBIs) account for up to 20% of all injuries in boxing. Approximately 97% of sports-related brain injuries are mild, their neurological symptoms are unexpressed, and young, strong, highly motivated athletes tend to dismiss the severity of their injuries. This may lead to an underestimation of the severity and extent of brain injuries. Changes in computed tomography (CT) and magnetic resonance imaging (MRI) in mild traumatic brain injury are absent in the early stages, making diagnosis difficult. Frequent repetitive traumatic brain injuries, including mild brain injuries, can result in functional and structural brain lesions that affect athletes’ performance and, in the long term, significantly impair their quality of life. Also, the consequences of cerebral brain injuries, including mild brain injury, can be affected by the individual condition of the Circle of Willis.

Background: Diabetes mellitus is a serious long-term condition with a major impact on the lives and well-being, of societies worldwide. Poor disposal practices of devices potentially result in personal injury and injuries to people in the household and the general community. This study aimed to assess the knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in TASH, Addis Ababa, Ethiopia. Method: A cross-sectional study was conducted among 182 adults with diabetes. The study participants were selected through systematic random sampling. Data were collected from March/17/2020 - May/18/2020. Patients were interviewed using a structured questionnaire. Data were entered into Epi-data version 4. 6 and exported to SPSS version 25.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Good practice and adequate knowledge were defined based on median calculation; a result above the median value of good practice and adequate knowledge with a p - value < 0.05 was considered to declare a result as statistically significant.Results: About 54% of the participants had inadequate knowledge about safe insulin injection waste disposal. More than two-thirds (73%) of respondents had poor practice and 92.3% of respondents did not know how to dispose of lancets after use.Conclusion: This study revealed that the knowledge and practice of diabetic patients were inadequate and poor towards safe insulin injection waste disposal in the study area. Educating patients and awareness creation training on proper insulin injection device disposal should be considerable. 

Alcohol drinking habit is a serious epidemic that afflicts people worldwide regardless of socioeconomic class and the country’s development or civilization. The purpose of this systematic review was to summarize research findings on drinking and driving, its implications for Nigerian society, and the role forensic science can play in drunk driving. Nigeria, in particular has seen a lot of fatal accidents attributed to alcohol but due to a lack of forensic sobriety and toxicology drug tests at the crash scene that is not yet in place in the country, the offenders are not punished for this crime. The only two African countries that have legislation on Blood Alcohol Concentration (BAC) are South Africa and Zimbabwe. Nigeria has no such legislation and does not conduct such tests in injury and fatal accident cases. The prevalence of drinking habits among Nigerians and in particular the drivers cannot be ignored. This study examined global drinking habits including its prevalence in Nigeria and more importantly understudied the need for forensic science interplay in a criminal investigation against drunk driving in the country. Drunk driving in Nigeria is a serious problem. Establishing and enforcing drunken driving laws as a criminal offense would assist the country in the reduction of road accidents, injuries, and fatalities relating to road accidents. Forensic science is a unique field that is equipped with skills and knowledge that could be useful for criminal investigation in the country including accident cases. Forensic scientists have outstanding technical skills to identify, detect, and even assist the country’s prosecutors in the administration of justice in crime investigations. Nigeria as a country will be well served if forensic scientists work in partnership with the government. Drinking and driving in addition to other crimes has become a matter of concern. The country’s police force and courts still rely mostly on eyewitness circumstantial evidence, testimonies, and suspects’ confessions. Based on this, I personally believe that the advent of Forensic science in the country’s system will assist a great deal in solving crimes and reducing fatal accidents due to drunk driving.

Background: Elite handball female players are at high risk of injury to the lower limbs. The modified Star Excursion Balance Test (mSEBT) is efficient in detecting players with a risk of injury. However, performed once before the season, the mSEBT cannot determine with precision when the injury will occur. Purpose: The objective of the study was to investigate if a repeated measure of mSEBT across the season would help in identifying with precision the period at risk of injury for each player.Methods: Eleven elite female handball players took part in the study. The mSEBT was measured weekly for 25 weeks and the injuries were recorded. Composite Scores (CS) and distances on each axis were computed for both legs of each player. The 94% cut-off on the composite score and the 4 cm difference between the right and left leg on the anteroposterior axis (ANT) was investigated for each player.Results: Five players reported injury. The 94% cut-off on the CS and the 4 cm difference on ANT were not significant indicators of risk of injury in our study. However, for each injured player, a drop in the composite score was noticed the week before the injury.Conclusion: We propose the drop of CS as an indicator for the detection of the risk of injury in a follow-up of elite athletes using repeated mSEBT. This indicator allows the detection of injury a week before it occurs. Further work is needed to confirm, investigate and validate this indicator.

Jatropha dioica sesse ex cerv is a specie native to Mexico and Texas, commonly known as “sangre de drago“, its name is due to its colorless juice turning dark at exposure to the wind. This mini-review aims to collect information about the phytochemical and pharmacological properties of Jatropha dioica. The phytochemicals identified are diterpenes, (citlalitrione, jatrophone and riolozatrione), β-sitosterol, oxalic acid and ellagic acid. The stems, whole plant, or the root of J. dioica in traditional medicine are used to avoid hair loss, as an antibacterial, and antiviral, to strengthen teeth, and to heal some injuries among others uses. Among the biological activities attributed to Jatropha dioica are found in antiviral activity, antifungal, antimicrobial, chemopreventive, anti-hyperglycemic and cytotoxic. However, the little information about the chemical composition of this species and the scarce scientific studies validating its pharmacological properties make J. dioica an interesting species to study.

Study design: Descriptive study.Background: Many risk factors contributing to ankle sprains have been studied in medical literature with coordination and balance being two of the major endogenous factors described. These are influenced by lateralization – a developmental and adaptive ability determined by the asymmetrical construction of the human brain, with cross-laterality referring to mixed limb dominance.Objectives: To determine whether cross lateralization is a risk factor for the severity of ligamentous injuries in ankle sprains since no data is yet available on such correlation. Methods: Two hundred forty-four patients with acute ankle sprains (136 men and 108 women) were prospectively evaluated between April 2006 and March 2009. The mean age was 30 (ranging from 18 to 76). Clinical and ultrasonographic examinations were performed on the study subjects. Laterality was then assessed by the Coren questionnaire and the AOFAS score was calculated. Patients with syndesmotic injuries and fractures were excluded from the study. Those qualified were divided into straight and crossed groups, according to their laterality type. Results: One hundred forty-four patients displayed straight lateralization, while cross-laterality was found in 100 subjects. Patients in the crossed group experienced more multi-ligamentous injuries than those in the straight group (p = 0.02). Following trauma, a higher AOFAS score was attributed to subjects that displayed a straight lateralization pattern, in comparison to subjects presenting with crossed laterality (p = 0.04).Conclusion: Crossed lateralization is associated with higher severity of ligament injuries in ankle sprains and may be considered a risk factor for calcaneofibular ligament injuries.

Background: It is unknown what effect the menstrual cycle can have on the susceptibility to trauma following sexual assault. Objectives: To compare the incidence of genital injuries following sexual assault in women with relationship to the three phases of the menstrual cycleMethods: The design was a retrospective, cohort analysis set in a community-based nurse examiner program over a five-year study period. Sexual assault victims were between the ages of 13 - 40 years and agreed to a forensic examination. The menstrual cycle was divided into three phases: follicular, luteal and menses phase. The primary outcomes were the frequency and type of genital injuries documented in relation to the different phases of the menstrual cycle.Results: Case files of 1376 cases of sexual assault were reviewed; 682 (49.6%) met the inclusion criteria. A total of 220 victims (32.3%) were in the follicular phase, 361 (52.9%) were in the luteal phase and 101 (14.8%) were in the menses phase. The three groups were comparable in terms of demographics, assault characteristics, and overall frequency of non-genital injuries. Assault victims in the follicular phase of the menstrual cycle had significantly more documented genital injuries (72.3%; 95% CI 66.4 - 78.2) compared to the luteal phase (64.0%; 95% CI 59.0 - 68.9) and the menses phase (58.4%; 95% CI 48.8 - 68.0). Conclusion: Forensic examiners documented more genital injuries in the follicular phase of the menstrual cycle. Sex hormones may have confounding effects through influences on vaginal epithelial and mucosal integrity.