An IoT-Based Mobile System for Safety Monitoring of Lone Workers

The European Agency for Safety and Health at Work considers Smart Personal Protective Equipment as “Intelligent Protection For The Future”. It mainly consists of electronic components that collect data about their use, the workers who wear them, and the working environment. This paper proposes a distributed solution of Smart Personal Protective Equipment for the safety monitoring of Lone Workers by adopting low-cost electronic devices. In addition to the same hazards as anyone else, Lone Workers need additional and specific systems due to the higher risk they run on a work site. To this end, the Edge-Computing paradigm can be adopted to deploy an architecture embedding wearable devices, which alerts safety managers when workers do not wear the prescribed Personal Protective Equipment and supports a fast rescue when a worker seeks help or an accidental fall is automatically detected. The proposed system is a work-in-progress which provides an architecture design to accommodate different requirements, namely the deployment difficulties at temporary and large working sites, the maintenance and connectivity recurring cost issues, the respect for the workers’ privacy, and the simplicity of use for workers and their supervisors.

The Dilemma of Falls in Older Persons: Never Forget to Investigate the Syncope

Background and objectives: Falls represent a major cause of morbidity, hospitalizations, and mortality in older persons. The identification of risk conditions for falling is crucial. This study investigated the presence of syncope as a possible cause of falls in older persons admitted to a Sub-Acute Care Unit (SACU) with a diagnosis of accidental fall after initial management in an emergency department and acute hospitalization. Materials and methods: A retrospective monocentric study of patients aged ≥65 years, consecutively admitted to a SACU with a diagnosis of fall-related trauma. All patients underwent a complete assessment of the index event and clinical status. Patients were categorized into three groups according to the identified cause of falls: (1) transient loss of consciousness (T-LOC), (2) unexplained fall (UF), and (3) definite accidental fall (AF). Results: A total of 100 patients were evaluated. T-LOC was present in 36 patients, UF in 37, and AF in 27. Of the 36 patients with T-LOC, a probable origin was identified in most cases (n = 33, 91%), 19 subjects (53%) had orthostatic hypotension, 9 (25%) a cardiac relevant disturbance, 2 (6%) a reproduced vaso-vagal syncope, 2 (6%) severe anemia, and 1 (3%) severe hypothyroidism. The T-LOC group was older and more clinically complex than the other groups. Conclusion: In older patients who recently experienced a fall event, the prevalence of syncope is relevant. In frail and clinically complex patients with falls, the identification of the underlying cause is pivotal and can be achieved through prolonged monitoring and a comprehensive assessment of the person.

Lenz microphthalmia syndrome in neurosurgical practice: a case report and review of the literature

Lenz microphthalmia syndrome (LMS) is an allelic X-linked syndrome correlated to a null mutation of B cell lymphoma (BCL-6) corepressor (BCOR) gene, which is essential in the early embryonic development. Phenotypically, this rare hereditary syndrome is characterized by microphthalmia/anophthalmia and other eye disorders; mental disability; dental, ear, and digital abnormalities; and variable malformations affecting the heart, skeleton (limbs and/or spine), and genitourinary tract. In this paper, a case of a young adult with LMS affected additionally by immuno-hematological disturbances was treated with decompressive craniectomy after domestic accidental fall. Case description and a brief review of the current literature about this rare condition are presented here.

A case report of blunt liver trauma in times of COVID-19 pandemic

The liver is one of the most affected organs in abdominal trauma mostly because of its considerable dimensions, the fragility of the liver parenchyma.We present the case of a 29-year-old patient who sustained an abdominal trauma after an accidental fall from a 3 m height. The patient tested positive at RT-PCR for SARS-CoV-2 at admission, without any symptoms of viral infection. The emergency CT scan revealed a blunt liver trauma with an expanding hematoma (grade III). The patient was initially hemodynamically stable but shortly after admission became unstable and required surgical treatment that initially consisted of damage control and liver packing. Reintervention was decided 36 hours later, after reevaluation unpacking and hepatorrhaphy were done. The postoperative evolution was uneventful. The case indicated the importance of continuous monitoring of the traumatic patient. In liver trauma, hemodynamic instability guarantees an emergency laparotomy. The time of operations in trauma patients with SARS-CoV-2 must be reduced to the maximum both as an objective of damage control and also to minimize the risk of contagion.

OCCULT INTRACRANIAL INJURIES ON COMPUTED TOMOGRAPHY (CT) HEAD SCANS IN INFANTS INVESTIGATED FOR SUSPECTED PHYSICAL ABUSE: A RETROSPECTIVE REVIEW

Background United Kingdom national guidelines recommend that investigation of infants (aged <12 months) with suspected physical abuse should always include computed tomography (CT) head scans. Studies report a range of yields for occult intracranial injuries in infants. Aims To gauge the yield of occult intracranial injuries on CT head scans in infants who underwent radiological investigations for suspected physical abuse, and compare selected demographic, clinical and radiological features in infants with and without intracranial injuries. Method A retrospective cross-sectional review of infants investigated for suspected physical abuse in Wessex, England. The main outcome measure was yield of occult intracranial injuries on CT head scan. Occult injuries were defined as previously unsuspected CT head scan findings of postnatal intracranial injury. Results Of 363 CT head scans meeting study criteria, 68 were in infants with neurological signs or skull fractures, 36 of these had intracranial injuries. Of the 295 without neurological signs or skull fractures, just 1 infant had CT features of an intracranial injury. This was the only occult intracranial injury found. It was a small cortical haemorrhage found to be consistent with a contracoup injury from an accidental fall. No additional demographic, clinical or radiological features were associated with intracranial injury. Conclusion In suspected physical abuse, CT head scans should be carried out in infants who present with neurological signs, or who have skull fractures identified on X-ray. However, we question the benefit of performing CT head scans routinely in infants who have no signs of head injury.

Effect of Adding Proprioceptive Exercise to Balance Training in Older Adults with Diabetes: A Systematic Review

Introduction: Accidental fall is a serious problem in older adults. The incidence of accidental fall increases by any dysfunction in the proprioceptive system. The function of the proprioceptive system usually is much affected in people with Diabetes Mellitus (DM), particularly in older ages. However, proprioceptive exercise significantly improves the balance control in older adults, no systematic review demonstrated its effectiveness in improving the balance control in older adults with DM. Thus, this systematic review was conducted to examine the effectiveness of adding proprioceptive exercise to any balance training in older adults with DM. Methods: A systematic search was performed in five major databases. The inclusion criteria of this search included older adults with DM, peripheral neuropathy, randomized control trial, and proprioceptive dysfunction. The exclusion criterion of this search included any study where participants had a history of a disease that might affect the balance control such as ataxia, stroke, and Parkinsonism. The outcome of interest was the importance of including proprioceptive exercise in increasing the effectiveness of balance training in older adults with DM. Results: Nine RCTs met the inclusion criteria for this systematic review. Seven studies of these nine studies included randomization details. Only two studies included the blindness, and only one of them included double blindness. The description of the withdrawal of participants was shown in eight studies. All the included studies used a control group and accomplished the homogeny between subjects in the both groups. Conclusion: This systematic review showed that proprioceptive exercise is a vital component that should be included in any balance training to gain short-term improvement in the balance control in older adults with DM.

Fatal positional asphyxia following a fall in bathroom

A 27-year-old female student was found dead inside the bathroom of her university hostel. The body was in a prone position with her neck over-flexed on to her trunk. The medico-legal autopsy found features of asphyxia. Multiple lacerated wounds were present on the occipital region of scalp. The cause of death was opined as positional asphyxia following an accidental fall and blunt trauma to the head. In this case, concussion due to blunt trauma to the head may have precluded any self-rescue efforts by the victim from the floor leading to positional asphyxia.