Surgical treatment of post-traumatic luxation of rib heads with spinal cord compression in a cat

Background Luxation of the rib head with intrusion into the intervertebral foramen seems to be rare in cats. Only one report has been published describing a cat with non-ambulatory paraparesis, which was managed conservatively. Here we report a case of rib head luxation that was managed surgically. Case presentation A 4-year-old, female domestic shorthair cat with a two-week history of non-ambulatory paraparesis was presented at our clinic. Based on history and neurological examination, a diagnosis of thoracolumbar spinal cord lesion of traumatic origin was made. Computed tomography scanning revealed mild scoliosis, a luxation of the 3rd and 4th right rib heads and penetration into the spinal canal through intervertbral foramina. Surgical management using right dorsal approach to the spine was performed. The spinal cord was decompressed by cutting and removing of proximal ribs’ fragments by rotation and pulling out from the intervertebral foramina. The cat was ambulatory and paraparetic four weeks after surgery. Two years after surgery the cat regained functional gait, but ataxia remained. Conclusions We report the first case of a surgical treatment of rib head luxation and intrusion into the spinal canal in a cat. The applied procedure resulted in an improvement of neurological signs.

Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method

Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Malawi, estimating the associated need for services provision, with a focus on traumatic aetiology. Methods The KIM was conducted in the districts of Thyolo (Southern Malawi) and Ntcheu (Central Malawi) in 2013. Five hundred key informants were trained to identify children who may have one of a range of MSI. The identified children were referred to a screening camp where they were examined by medical experts with standardised assessment protocols for diagnosing each form of impairment. Results 15,000 children were referred to screening camps. 7220 children were assessed (response rate 48%) for an impairment of whom 15.2% (1094) had an MSI. 13% of children developed MSI from trauma, while 54% had a neurological aetiology. For MSI of traumatic origin the most common body part affected was the elbow. Less than half of children with MSI (44.4%) were enrolled in school and none of these children attended schools with resources for disability. More than half of children with MSI (60%) had not received required services and 64% required further physical therapy. Conclusions The KIM method was used to identify a high prevalence of MSI among children in two districts of Malawi and estimates an unmet need for dedicated MSI services.

Abstract 13678: Validation of the Termination of Resuscitation Rules in Detroit

Introduction: 326,000 patients suffer from an out of hospital cardiac arrest (OHCA) each year. The Termination of Resuscitation (TOR) criteria, which recommends termination when the arrest is unwitnessed by EMS, no shocks are administered, and no ROSC occurs, guides physicians in determining the futility of continuing CPR and transporting patients to the hospital. We examined compliance with current BLS TOR rules as well as assessed an alternate set of rules, with the goal of retrospectively deriving improved TOR guidelines for OHCAs in Detroit. Methods: This is a retrospective study utilizing non-traumatic OHCA cases in Detroit from January 1, 2017 to December 31, 2019, which includes time before and after BLS TOR guidelines were officially implemented (June 1, 2018). Data is extracted from the Detroit Cardiac Arrest Registry (DCAR). Patients younger than 18 years of age and arrests of traumatic origin or those with no resuscitation attempted were excluded. Results: BLS TOR criteria was applied to the pre-TOR implementation data with resulting specificity of 79% (95% CI: 50.7-80.8) and PPV of 97.3% (95% CI: 95.5-98.6). Survival to hospital discharge when termination was recommended was projected at 2.9% (13/444). Overall transportation rate was 85% (559/656). Post-TOR implementation, specificity was 88.9% (95% CI: 78.6-99.1) and PPV was 99.1% (95% CI: 98.3-99.9). Survival to hospital discharge was 0.88% (4/453) with a 69% (451/650) overall transportation rate. Post-hoc addition of age or EMS time to patient side increased transportation rates to 81% (529/650) and 88% (571/650), respectively, and decreased false positive terminations to 0.84% (2/237) and 0% (0/148), respectively. Conclusion: Overall survival when TOR was recommended as well as futile transportation rates decreased since the implementation of the BLS TOR guidelines in Detroit. Addition of EMS time to patient side or patient age to the current TOR guidelines suggested improved performance. Although the additional criteria resulted in higher transportation rates, these factors may be useful for physicians to consider when deciding to transport patients who meet the current TOR criteria. However, further derivation and validation are needed to create optimal TOR guidelines.

TO DEVELOP FORENSIC CRITERIA FOR THE DIFFERENTIAL DIAGNOSIS OF INTRACEREBRAL HEMORRHAGE OF TRAUMATIC AND NON-TRAUMATIC ORIGIN USING MUELLER-MATRIX MICROSCOPY OF LINEAR DICHROISM

Differential diagnosis of intracerebral hemorrhage due to traumatic and non-traumatic origin is a challenging issue, especially in the absence of visible body injuries and other signs of violence. For a forensic expert-practitioner, the main thing is objectivity, accuracy, and speed of obtaining the result, which could fully satisfy the methods of laser polarimetry in the case of differential diagnosis of hemorrhages of traumatic and non-traumatic origin in the human brain matter. The purpose: To develop forensic criteria for the differential diagnosis of intracerebral hemorrhage of traumatic and non-traumatic origin using Mueller-matrix microscopy of linear dichroism. Materials and methods: The object of the study was brain matter samples, collected in 115 corpses of both sexes aged 22 to 86 years with accurately known causes of death. The causes of death included coronary artery disease, traumatic brain hemorrhage, ischemic brain infarction, and non-traumatic brain hemorrhages. Brain matter samples have been frozen rapidly, and histological sections have been made using a freezing microtome. The slices have been evaluated using the method of azimuthal-invariant Mueller-matrix microscopy, followed by mathematical and statistical processing of the results. Results: significant topographic heterogeneity of Mueller-matrix invariants of brain matter samples linear dichroism maps among all research groups have been found. Individual and significant variations of dispersion, asymmetry, and kurtosis magnitude have confirmed the heterogeneity of Mueller-matrix invariants. The difference of images and histograms among groups is explained by the presence of necrotic changes in the case of ischemic brain necrosis and blood cells in the brain matter samples. For the set of central statistical moments of the 1st, 3rd, and 4th orders, which characterize the distributions of circular dichroism, the method of MM-microscopy in the differentiation of samples of non-hemorrhage and hemorrhage groups reaches a satisfactory level - 78% - 84%. Conclusions: Brain matter samples Muller-matrix microscopy of linear dichroism is effective for solving diagnostic problems of forensic medicine related to evaluating the cause of death from intracerebral hemorrhage of various origins. Diagnostic efficiency of Mueller-matrix mapping of polarization manifestations of linear dichroism method for intergroup differentiation of samples of deaths from traumatic hemorrhage (Group 2) and ischemic cerebral infarction (Group 3) reaches a satisfactory level of 79 - 84%.

On the issue of birth injuries of the urinary tract of a woman

With minor exceptions, urinary incontinence after childbirth has a traumatic origin. It can be the result of two different reasons, namely, the result of a long standing of the fetal head in the cavity or, more often, in the entrance of the small pelvis and the associated prolonged pressing of the underlying tissues, of which the anterior wall of the vagina with the posterior wall of the bladder and the urethra suffers or re as a result of surgical interventions undertaken for the purpose of delivery without the necessary conditions, more often with an empty bladder and with an unprepared birth canal.

About dry pleurisy of traumatic origin

The issue of dry pleurisy of traumatic origin has not yet undergone a comprehensive and thorough study, while this type of pleurisy has in its clinical course a number of characteristic and specific features that sharply distinguish them from dry pleurisy of another, non-traumatic etiology.

Oral Healthcare and Idiopathic Thrombocytopenic Purpura: Early Recognition, Dental Management and Case Report

A 47-year-old Caucasian man, in good general, oral and periodontal health, presented with a non-bleeding bluish lesion on the back of his tongue, presumably due to an ecchymotic area of traumatic origin which was left untreated. The day after, other ecchymotic-type lesions on the mucous membranes of the cheeks and the upper lip, a bleeding lesion at the apex of the tongue and gingivorrhagia, along with petechiae on the back, scalp, lower limbs and feet, occurred, with rapid clinical deterioration, requiring immediate hospitalization. Oral, dermatological, and hematological evaluations lead to idiopathic thrombocytopenic purpura (ITP) diagnosis and hydrocortisone prescription, with a complete recovery in the next few days.The presented case of ITP, with early intra-oral manifestations,aimed both to emphasize the role of oral healthcare workers in theearly recognition of ITP, which may be especially relevant for those cases with extremely fast platelet depletion, high risk of internal bleeding and consequent potentially fatal complications, and in the differential diagnosis of the diseasethat may be aided by the diagnostic protocol described, and to provide dentists with recommendations on oral care management of cases ofITP, both in dental and multi-disciplinary settings.

Bilateral Intracapsular Hip Fracture in a Patient With Low Functional Demand Treated With a One-stage Bilateral Hemiarthroplasties. A Case Report and Literature Review.

Bilateral femoral neck fracture is a rare injury. While they may be of traumatic origin, they are generally associated with some underlying condition that predisposes to this pathology, such as neurological disorders or bone metabolism diseases. We present an 83-year-old woman with severe osteoporosis who had a simultaneous bilateral intracapsular hip fracture.

Ungulomycosis of cattle: etiological factors and pathogenetic mechanisms

Mycotic diseases, ie those caused by microscopic fungi, are widespread among animals. As for cattle, at present ungulomycosis has become the most widespread, in which keratolytic fungi affect the hooves of animals, causing complications such as deformities, pododermatitis, lesions of the hoof bone. Ungulomycosis (from the Latin ungula – hoof, Gr. Mykes – fungus) – a disease of the hooves, which are caused by microscopic fungi that have keratolytic properties. In most cases of ungulomycosis, its complications are most often registered, and not the disease itself, which does not allow to carry out effective preventive measures and treatment of animals in a timely manner. That is why the purpose of the work was to study and concretization the main factor of the disease and the contributing conditions for the disease. For this purpose the basic and additional clinical methods of research were used, including microscopy of the destroyed horn and sowing on nutrient media to determine the species content of microscopic fungi. The research was carried out in the farms of the western regions of Ukraine on cows of Black-Spotted and Holstein breeds in the stall period with tethered animals. It is found that the pathogenic action of microscopic fungi-keratomycetes on the hooves of cattle is carried out in the presence of favorable conditions of external and internal nature, primarily insufficient housing conditions and poor feeding. In particular, for osteodystrophy due to ungulomycosis, the destruction of the hoof's horn is accelerated, which complicates the pathological process. For purulent subdermatitis of traumatic origin, microscopic fungi-keratomycetes act as an additional or contributing factor to the disease. Further research will focus on the development of effective treatments and measures to prevent ungulomycosis.