Injury
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We examined the management and outcome of patients suffering complex paediatric lower limb injuries with bone and soft tissue loss. ⋯ Limb salvage and timely fracture union is possible in children with complex lower limb trauma. Early intervention providing adequate debridement, skeletal stabilisation and early soft-tissue cover including the option of free microvascular reconstruction in small children when required, delivers acceptable outcomes. A multidisciplinary team approach including clinical psychologists to address the psychological impact of trauma provides optimal holistic care for these children and adolescents. Therefore, treatment for these patients should only be performed in paediatric major trauma centres.
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Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries. ⋯ There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.
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Poor awareness among the patients and lack of resources for proper management of nerve injuries leads to delayed presentation of most traumatic ulnar nerve injuries. When this injury is present in the proximal forearm it leads to poor outcomes as Ulnar nerve repair with grafts takes a prolonged time to restore function. Addition of a tendon transfer to this procedure can allow patients to return to work earlier. The purpose of this study is to examine whether the addition of a tendon transfer to nerve repair surgery will lead to improved hand function and rehabilitation earlier than nerve grafting alone in cases of delayed presentation of Ulnar nerve injuries. ⋯ On comparison of employment status at 6 months we found that among the tendon transfer group 15/20 (75%) were employed while only 4/16 (20%) in the control group were able to return to work. Chi square test shows a p value of 0.002 (significant at p < 0.05). On evaluation at end of 1 year after surgery we found 18/20 (90%) had returned to work in the tendon transfer group while 8/16 (50%) had found employment again in the control group. Chi square test shows a p value 0.007 (significant at p < 0.05) CONCLUSION: These outcomes suggest that addition of a tendon transfer with nerve grafting promotes early rehabilitation, especially in patients employed in manual labor.
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Benzyl alcohol (BnOH) is a natural colorless liquid organic compound that plays an important role in bacteriostatic and anesthetic processes. It is also used to relieve the nerve and ganglionic pain. In this study, we assessed the effect of topical application of BnOH on the Achilles tendon healing process. ⋯ To study the mechanism of the process, the expression of mRNA of TGF-β1, Smad2/3 and Smad7 and protein of TGF-β1, p-Smad2/3 and Smad7 were quantified by real-time PCR and Western blotting, respectively. Results of this study showed that wounds treated with BnOH significantly enhanced the expression of TGF-β1 and Smad2/3 and reduced the expression of Smad7. In general, the current study demonstrated that BnOH improved the recovery process of tendon healing through the promotion of collagen with angiogenesis and showed that TGF-β plays a role in BnOH treatment of tendon healing.
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To analyze epidemiology, pattern, and management of pediatric maxillofacial trauma in North China. ⋯ The primary cause of pediatric maxillofacial fractures in North China was falls; traffic accidents led more multiple fractures and associated injuries. Palate and mandible were the most common sites of pediatric maxillofacial soft tissue injuries and fractures, respectively. The proportion of mandibular fractures to mid-face fractures decreased with the increase of age until 12.