Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define ...the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 10 –13 and 3 (4.8%) with TS <9. More frequent extraabdominal associated lesions were: head injuries – 38 (58.5%), thoracic trauma – 34 (52.3%), orthopedic injuries – 24 (36.9%). Diagnostic peritoneal lavage was performed in 5 (7.8%) cases. FAST has a sensibility of 70.21% and CT scan a sensibility of 100%. Most frequent injured abdominal organs were the spleen – 36 (56.25%), liver 17 (26.56%) and mesentery 14 (21.87%). Laparotomy was performed in 59 (92.2%) of cases, laparoscopy in 2 (3.1%) of cases and conversion to open surgery in 3 (4.7%) cases. Mortality was 23.43%. We observed several predictive factors for mortality on univariate analysis: haemoglobin < 8g/dl (p=0.02), haematocrits < 25% (p=0.01), hemoperitoneum > 1500 ml (p=0.04), colonic trauma (p=0.001), head (p=0.01) and thoracic injuries (p=0.04). Dedicated trauma surgeons should balance between trauma kinetics details, patients’ clinical examination, and diagnostic workup, in an effort to decrease morbidity and mortality secondary to missed injuries or unnecessary laparotomies.
Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring experience in terms of trauma and colorectal surgery. Case report and electronic search of the U.S. ...National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Case 1 - Male patient, 31 years old, victim of a car accident, transferred to our hospital from a lower level trauma center, with cranial, abdominal and extremity trauma (ISS = 29). On FAST there was free peritoneal fluid. The patient was transported to the operating room. Abdominal exploration revealed a grade IV laceration of the sigmoid colon and upper rectum, with diffuse fecaloid peritonitis and middle hemoperitoneum. Hartmann type colorectal resection was performed. Postoperative whole body Computed Tomography detailed the complex type C pelvic fracture, immobilized with an external fixator during initial surgical approach. The clinical evolution was favourable, the patient being referred to a lower level local center for rehabilitation. Case 2 - Male patient, 27 years old, bicyclist victim of a car accident, admitted to our hospital in emergency setting for right inguinal open wound with extension to anorectal region and pelvis-subperitoneal space, complex pelvic trauma and lower limb fractures (ISS = 29). The patient was transported to the operating room. Perineal packing was performed with external pelvic fixation and lower limb fractures reduction along with external fixation. The clinical evolution was favourable, the patient being referred to a lower level local center for continuation of the therapy. Significant injuries to the pelvic ring, most commonly the result of high energy trauma, carry with them high rates of both morbidity and mortality, and only prompt diagnosis and treatment are the key to success.
Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients.The cornerstones in the management of ...complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria.An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.
ObjectivesThis study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease ...(GBD) 2016 study.MethodsThe GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors.ResultsIn 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39–1.68) million deaths and 76.1 (66.3–86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs.ConclusionsOccupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.
Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease ...(GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time.
Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated.
In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs.
Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people.
The Bill and Melinda Gates Foundation
Nonoperative management (NOM) of liver trauma is currently rather the rule than the exception. However, the current evidence presents subgroups of patients at higher risk for NOM failure. These ...patients must be treated more cautiously regarding the NOM approach.
A case report of 3 polytrauma patients (Injury Severity Score > 17) with high-degree liver trauma managed nonoperatively.
The first case presented is the one of a polytrauma patient with degree IV liver injury and impaired mental status. It was a high risk for NOM failure because there was an angiographically hemostasis. The second case is one of a polytrauma patient who became hemodynamically stable after the administration of 2000 ml of fluid intravenously. There was a nonoperative approach with angiography and embolization of degree IV liver injury. Despite the success of the nonoperative treatment, there was an important hepatic necrosis following embolization. The third case is one of a polytrauma patient with a degree IV hepatic injury. Success was accomplished in NOM without an angiography.
Nonoperative management of liver injuries can be applied safely even in high degree hepatic trauma. In hemodynamically metastable patients or impaired mental status patients, the nonoperative approach can be applied successfully, but the trauma surgeon must be very cautious.
The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of ...disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.
We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).
In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%).
There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.
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