Online ISSN: 2515-8260

Keywords : trauma


A study to analyze vocal cord palsy with reference to nerve involvement presenting in tertiary care hospital in Eastern India

Dr. Amit Kumar Sharma, Dr. Mahesh Kumar, Dr. Rakesh Kumar Singh, Dr. Sarita Kumari Mishra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1321-1327

Background: Common causes of vocal could paralysis are neoplasms (bronchial, esophageal, thyroid), trauma, idiopathic, neurological, inflammatory & miscellaneous. With limited resource at our disposal, present study was aimed to find out etiopathology & classification of vocal cord palsy at our tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in confirmed cases of vocal cord paralysis.
Results: This study was done on 44 patients of vocal cord paralysis. Majority were from 41-50 years age group (29.55%) followed by 51-60 years age group (20.45%). Sex incidence in this series revealed 27 male cases and 17 female cases. In present study common causes of vocal cord paralysis were Neoplastic growth (32%) followed by surgical trauma (30%), Blunt Trauma over front of neck (4%), pulmonary tuberculosis (11%), Idiopathic (16%), Cardiac hypertrophy (4%), cranial polyneuritis (4%) & Corrosive ingestion (4%). Left cord palsy, right cord paresis and bilateral paresis was noted in 55%, 27% & 18% cases respectively. 8 patients in this study were suffering from bilateral vocal cord paralysis and rest of the patients (36) had unilateral paralysis. So total number of paralyzed cords was 52. Out of these, 47 vocal cords were paralyzed completely and incomplete paralysis was seen in case of 5 cords. n most of the cases (27) it was in paramedian in position. Paralyzed cord was in midline in 12 cases, cadaveric in 8 cases. Incomplete palsy with restricted mobility was seen in 5 cases.
Conclusion: Neoplastic growth, trauma (surgical and non-surgical) & pulmonary TB were most common causes for vocal cord paralysis. Vocal cord paralysis was common in male patients, on left side & unilateral involvement.

A Study on Physiological Causes and Temporal Pattern of Trauma Death in a Tertiary Care Trauma Centre

N. Niranjan Kumar, M. Emil Phinehas, Angeline Neetha Radjou, Ashwin Chand .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3165-3173

Background: Trauma is a major public-health problem in India. With a population over one billion and an annual urbanization rate of 26%, the magnitude of the problem is a cause for concern. An unpresented increase in number of vehicles has outpaced the development of adequate roads and highways. Trauma especially RTA’S are the invariable fall out in the rapid motorization and urbanization in India. Aim: To study the physiological causes and temporal pattern of trauma death in the study population.
Materials and Methods: Study Design: Institutional based Retrospective and prospective study. Study area: The study was done in the Department of in medical college. Study Period: Retrospective period of 6 months and Prospective for 6 months. Study population: All trauma patients fatalities in the hospital and Patients brought dead to accident and emergency. Sample size: A total of 92 patients were included in the study. Prevalence of head injury = 60% (last year records) with an Absolute precision of 10% at 95% confidence interval. Required sample size = 92. Sampling method: Simple Random sampling method. Ethical consideration: Institutional Ethical committee permission was taken prior to the commencement of the study. Study tools and Data collection procedure: All severely injured patients will be evaluated from the time they arrive to the duration of stay in the hospital and eventual cause of death will be estimated. The reported time of death will be noted and its significant pattern of trauma deaths will be noted. A graphical illustration of modal distribution of death with a simple bar diagram showing the physiological cause of death and time duration from 0 - 6 hours, 6 – 12 hours, 12 – 24 hours, 24- 48 hours, 48 – 72 hours ,72 hours – 1 week, > 1 week will be done respectively. Statistical Analysis: The data was collected, compiled and compared statistically by frequency distribution and percentage proportion. Quantitative data variables were expressed by using Descriptive statistics (Mean ± SD). Qualitative data variables were expressed by using frequency and Percentage (%).
Results: Among these causes in our study Intractable intracranial hypertension was seen in 63% (n-58) cases, Hemorrhagic shock/ Bleeding 25% (n- 23), Sepsis/Multi organ failure 6% (n– 5), Intracranial Hypertension and Sepsis 3% (n- 3), Ventilation associated Problems 1% (n- 1), Intracranial Hypertension and Hemorrhagic shock 1% (n – 1), Hemorrhagic Shock and Sepsis 1% (n- 1).
Conclusion: Retrospective judgments on clinical decision-making, based on case record findings, must be examined with extreme caution, and this study has been careful to use only objective parameters, like prolonged operative time, or pre-operative physiological status. If the results remain valid in other Indian hospitals, it is worth noting that better identification and management of trauma patients could save a quarter of million lives each year, based on a 50% reduction of the estimated half a million annual hospital trauma deaths in India.

A Review on the Evolution of Post Traumatic Haemorrhage Control

Waleed Badawyeh,Mohammad Abuzaid

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2846-2855

The mortality rate for trauma ranges from 1 to 34 years of age due to uncontrolled
hemorrhage. Trauma occurs for various reasons, including accidents and war zones.
Cumulative mortality among different traumatic experiences is the leading cause of death.
This has spurred the research community to focus on advancements in hemorrhage control to
control the trauma-related mortality rate. This review discussed numerous care options during
pre-hospitalization, operation theater, and emergency room, emphasizing emerging
methodologies, the challenges involved in controlling bleeding, and public health initiatives.

A Prospective Study to Assessment of Profile of Trauma Patients in a Tertiary Care Centre

Prashant Garhwal, B. S. Garhwal, Yusuf Ali Deora, Bimla Choudhary

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2240-2244

Background: Trauma is a major cause of morbidity and mortality in both developed and developing countries. The usual causes are road traffic accidents, fall from height, assaults, occupational injuries. The present study was conducted to assess profile of trauma patients in a tertiary care centre.
Materials and Methods: The present study was a prospective study of trauma patients carried over a period of 3 months.Details of history and physical examination findings of all patients were recorded. Triage priority level was noted. as follows: All patients had routine blood investigations and relevant radiological tests. In‑hospital outcome of all the admitted patients was noted. The recorded data was compiled, and data analysis was done.
Results: In the present study total trauma cases were 1800 in which 68.81% were males and 31.38% were females. Maximum trauma cases were in the age group 31-40yrs followed by18-30 yrs. Maximum injuries were of triage priority level 2 (57.33%). In two-wheeler, four-wheeler, auto, other vehicle accidents triage priority level 2 was in maximum patients. Two-wheeler accidents were followed by pedestrian injuries. Other modes of injury included fall on level ground, fall from height, assault had maximum injuries of triage priority level 2. In workplace injuries, sports injuries maximum injuries of triage priority level 3 and in others type of injury maximum injuries of Triage priority level 1. In head, face, thorax, spine, vascular, extremity maximum injuries were of triage priority level 2. In Neck, dorsum maximum injuries were of triage level 3. In abdomen maximum injuries were of triage priority level 1.
Conclusion: The present study concluded that road traffic accidents and falls were the major cause of trauma and the maximum injuries were of triage level 2.

A RETROSPECTIVE RESEARCH TO ESTABLISH THE CLINIC-DEMOGRAPHIC PROFILE AND OUTCOME OF INDIVIDUALS WHO PRESENTED WITH POSTERIOR FOSSA EXTRA DURAL HEMATOMA

Yadav P; Kolta N; Kaundal V

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1121-1124

Aim: to determine the prevalence and clinical profile of patients presented with posterior fossa extra dural hematoma. Materials and methods: This retrospective observational research was carried at the Department of Neurology, Apex Hospital, Jaipur, Rajasthan, India. The data for this research was collected during a 2-year period and was analyzed. The clinical presentation, admission Glasgow Coma Scale (GCS), mechanism of injury, type of intervention, and postoperative prognosis were all examined retrospectively in the data. The Glasgow Outcome Score (GOS) was used to evaluate the outcomes at the time of discharge and at three months after discharge. Results: There were 39 patients in all, 28 of them were men and 11 of whom were girls. There were 29.21 years between the mean ages of the patients. At the time of admission, 24 patients had GCS 13-15, followed by 9 patients with GCS 9-12, and only 5 patients had GCS less than 9. The mean EDH volume was 28.7 milliliters. Thirty-six patients were operated on, and five patients were treated conservatively. Conclusion: Epidural haematomas in the posterior fossa are a rather rare occurrence. Because of the limited volume of the posterior fossa and the presence of critical tissues inside it, mortality may be significant if the haematoma is not detected and treated promptly.

Assessment of impact of COVID- 19 on utilization of dental services

Dr. M. Vinuthna; Dr. Nandha Krishna Nambi; Dr. Saravanan Nambi; Dr. Neha Minocha; Dr. Aanchal Verma; Dr. Rakhi kumara

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 7904-7908

Background: The risk of SARS-CoV-2 transmission cannot be eliminated during aerosol-generating dental procedures in most dental settings. The present study was conducted to assess impact of COVID- 19 on utilization of dental services.
Materials & Methods: 485 patients who obtained dental treatment before and during COVID- 19 period were enrolled. Type of complaints for which patients visited dental offices was recorded.
Results: Out of 485, males were 310 and females were 175. During pre- COVID period, 170 patients <18 years and 210 above 18 years visited dental office while during COVID period, 40 below 18 years and 65 above 18 years reported to dental clinics. The common complaints were periapical seen in 120 and 45, cellulitis in 80 and 30, cellulitis in 70 and 10 and trauma in 110 and 20 in pre- COVID and during COVID period. The difference found to be significant (P< 0.05).
Conclusion: COVID- 19 had strong impact on utilization of dental services among patients.

PAN FACIAL FRACTURE – A CASE REPORT

Dr. Vijay Ebenezer; Dr. Rakesh mohan

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1505-1508

Pan facial fractures are complex to treat and hence have to be systematically managed . Several authors have quoted several principles regarding the repair of pan facial fractures in a stepwise fashion . The most important goal is to restore the occlusal relationship at the beginning of the treatment , so that all the other structures get aligned . The folllowing is a case of a traumatic pan facial fracture and its surgical management

Perosseous Osteosynthesis Andbone Plasty During The Treatment Of The Patients Opens Fractures Of Long Bones With The Extensive Defects Of Bone Tissue

Davirov Sharof Mazhidovich; Urinboev Payzulla Urinboevich

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 4472-4491

Introduction. In practice, an open comminuted fracture treatment severity of long bones, with an extensive defect in the diaphysis bone tissue, the bone metadiaphyseal part, is due to an increased risk combination of developing infectious complications due to an open infected wound, with the need to restore a significant volume of bone tissue, to connect the proximal and distal fragments of long bones. Internal osteosynthesis of bone fragments is impossible due to the lack of the required diaphysis bone tissue volume, the bone meta-diaphyseal part, necessary to restore the normal bones length,and performing open reduction, immediately after trauma, negatively affects blood supply, leads to the complications development such as soft tissue necrosis, infection, and suppuration.The article describes the staged fracture treatment method with the defect replacement with autobone, while maintaining the limb length, reducing the developing pathological risk processes.
Purpose of the study – to study the open double comminuted fractures treatment effectiveness of the patient's long bones, with an extensive defect in the diaphysis bone tissue or bone meta-diaphyseal part, by staging the transosseous fixation use with Ilizarov or the rod-rod apparatus, bone grafting with a fibula graft according to the classical technique and intramedullary osteosynthesis.
Results and discussion. A temporary transosseous extrafocal limb fixation was performed with Ilizarov or the wire-rod apparatus until the acute period subsided, edema decreased, and blood circulation improved.The fibula was harvested with a length suitable to the defect site.Intramedular metal osteosynthesis or internal osteosynthesis with smooth wires and an apparatus for external fixation of long bones with the bone defect replacement with an autologous bone from the fibula was performed.After bone fusion, external fixators, metal intramedullary implants and internal wires were removed.Achieved preservation of 
the anatomical segment length, satisfactory restoration of limb function, all fixing structures were removed, and the limb does not contain foreign bodies.
Conclusion. The various techniques and technical facilities combination, external fixation, autotransplantation using the classical technique and intramedullary fixation, made it possible to completely restore the injured limb, reduce the complications risk, and obtain good clinical results.

BIFID CONDYLE-

Dr. Kirthika. R; Dr. Balakrishnan Ramalingam

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 1861-1865

Bifid condyle an exceptional and a rare disorder presents with the duplication of the condyle head. Incidence rate- 0.31% to 1.82%. Szentpetery et al, the incidence of bifid condyle to be 0.48% in 1,882 cadaveric skulls. In 1941, Hrdlica first diagnosed on a 21 cases of specimen Smithsonian Institution in Washington DC of which 18 were unilateral and 3 bilateral. In 1948, Schier reported the first live case of bifid condyle. According to Cowan and Ferguson 1997, at least 36 clinical cases of BMC

MANAGEMENT OF LE FORT II FRACTURE FRACTURE – A CASE REPORT

Dr. Vijay Ebenezer; Dr. Shanmuga priyan

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1559-1564

Lefort classification is the historic classification which is widely used to classify mid facial fractures. The lefort classification was given by Rene Lefort ,who classified mid facial fracture into Lefort I , II and III. Lefort 2 fracture is referred as ‘ PYRAMIDAL or SUBZYGOMATIC FRACTURE .’ Lefort 2 is a floating maxilla which runs from the thin middle area of the nasal bones down either side , crossing the frontal processes of the maxilla into the medial wall of each orbit . Within the orbit , the fracture line runs across the lacrimal bone behind the lacrimal sac to cross the infra orbital margin medial to or through the infra orbital foramen . Extends downwards & backwards across the lateral wall of the antrum below the zygomaticomaxillary suture & divides the ptyergyoid laminae .Le fort fractures are blunt trauma facial fractures which involves specific pattern of facial bones injury. Pterygoid process of sphenoid bones is involved in all Le fort fractures. Lefort fractures are classified further depending upon the involvement of zygomatic, nasal and maxillary bones. Blunt facial traumas due to motor vehicle collision, assault, falls or sports injury are the most common causes. In our case, Le fort 2 fracture resulted from motor vehicle collision.

Superior orbital fissure syndrome – A review of literature

Dr. Vijay ebenezer; Dr. Balakrishnan Ramalingam

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1584-1586

Superior orbital fissure syndrome is a complex of cranial nerve impairment that affects the CN III, IV, V and VI all of which enters the orbit through the superior orbital fissure. Superior Orbital fissure syndrome occurs as a result of compression of all or some of these nerves passing through the fissure. Three major factors contributing to the syndrome includes traumatic injury, neoplasm and inflammation. This article takes into account the various data previously reported in literature and aims at providing a detailed knowledge about the anatomy of the superior orbital fissure to provide a better understanding about the syndrome

RECONSTRUCTION OF ORBITAL FLOOR FRACTURE– A CASE REPORT

Dr. Vijay Ebenezer; Dr. Wasim Ahamed

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1614-1618

Orbit is a conical cavity in which the base lies anteriorly and the apex directed at Optic Foramen .By Age of 5 years orbital growth is 85% complete, finalized between 7 years of age. Orbit is formed from 7 bones (Maxillary, Zygomatic, Frontal, Ethmoid, Larimal, Palatine, and Sphenoid ). It consists of Four Walls – roof, lateral, medial, floor .Medial wall and floor are thin ,While Lateral wall and Roof are Stronger. Floor of orbit is weakened due to infraorbtal Canal passing through it. In Pure blowout fracture one orbit wall is affected, without involving orbital rims. The inferior and medial walls are affected most frequently. Clinical features are diplopia, infraorbital nerve paresthesia , entrapment of soft tissue within the maxillary sinus, restriction of ocular movements and enophthalmos. CT scan is most helpful method for diagnosis of orbital fracture. For orbit reconstruction, natural and synthetic materials are available. We report a case of 21 years old man, diagnosed with orbital floor fracture after slip and fall from his two wheeler The surgical treatment involved orbital floor reconstruction with titanium mesh under general anesthesia. The outcome was satisfactory and during followup visual disturbances or paresthesia was not present.

Trauma Focused – Cognitive Behavior Therapy As An Innovation For The Prevention Of Trauma

Samsiah Mohd Jais; Mohammad Nasir Bistamam; Muhammad Bazlan Mustafa

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 4962-4971

This study aims to present the development result of the trauma focused – cognitive behavior therapy (TF-CBT) website and to test the percentages of agreement of the content, software interaction and technical aspects of TC-CBT website known as internet TF-CBT (iTF-CBT). The iTF-CBT module consists of five modules, namely i. Psycho Education; ii. TF-CBT; iii. Exposure Therapy; iv. Cognitive Therapy; and v. Anxiety Management. All of these modules are supported by 12 activities. Besides, this study is divided into two phases: i. Module development phase; and ii. iTF-CBT testing phase. The first phase involved data collection by conducting interviews with the experts as well as literature review. The second phase involved getting the percentages of agreement for the development of iTF-CBT among 42 trainee counsellors of the Sultan Idris Education University (UPSI). Results of this study indicate that the mean of percentages of the agreement between content, software interaction and technical aspects in the final test of iTC-CBT are high between 93 to 100 percents. These findings show that TF-CBT modules are applicable in the training to enhance efficiency of trauma and mental health counselling. As a result, this study has further expanded the theory and practices of counselling in the context of mental health particularly in Post Traumatic Stress Disorder (PTSD) and trauma.

Root fractures and its management in endodontics

Balasubramaniam Anuradha; Jayaraj Jenitha; Suresh Mitthra; Ramachandran Tamilselvi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 1649-1657

Fractures of crown and root are common emergencies encountered in the dental office. Root fractures are defined as fractures involving the dentin, cementum and pulp. These root fractures are broadly classified as horizontal/transverse and vertical root fractures. The correct diagnosis is essential to ensure proper treatment of root fractures. Various treatment strategies have been proposed, each has its own advantages and disadvantages. Hence this review article presents an overview of various types of root fracture, their diagnosis and clinical management

Effect of ketamine as an adjunct to opioid for pain control in traumatic patients

Mehdi Arzani Shamsabadi; Mohammad Darvishi; Masoud Shahabian; Seyed Zia Hejripour

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4438-4443

Background: Pain management results in better outcomes in traumatic patients in the emergency ward. Use of non-opioids facilitates the elimination of the adverse effects of opioid. Regarding this, the present study was conducted to examine the effect of ketamine as an adjunct to opioids for pain control in traumatic patients in a tertiary healthcare center in Tehran, Iran. Methods and materials: This double-blind randomized clinical trial was conducted on 160 traumatic patients admitted to the Emergency Department of Besat Hospital, Tehran, Iran, in 2018. The study population was randomly assigned into two groups of intervention and placebo. The intervention group one of which received 0.05 mg/kg opioid (i.e., morphine) plus 0.1 mg/kg ketamine, and placebo group the other one was provided with the same amount of morphine opioid plus placebo. The pain was recorded up to 120 min and compared between the groups. Results: Based on the obtained results, 23 (28.8%) and 16 (20%) patients in the ketamine intervention and control placebo groups had side effects, respectively, showing no significant difference (P=0.197). In addition, the pain significantly reduced in both groups (P=0.001). However, the results of repeated measures ANOVA revealed no statistically significant difference between the two groups in terms of pain reduction trend (P=0.275). Conclusion: Based on the results, it can be concluded that ketamine has no superior effect when administered as an adjunct to opioid for pain control in traumatic patients.

EVALUATION OF SITE PREDILECTION FOR SOCKET PRESERVATION

Nur Liyana Hannah Binti Izham Akmal; Revathi Duraisamy M.D.S

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 1887-1894

Changes in alveolar ridge in terms of volume, height and morphological features tend to be clinically significant and may result in difficulty for the placement of a conventional bridge or an implant-supported crown. Bone deformities or resorption from tooth removal can be prevented by a procedure called socket preservation. Studies have discussed the rationale of performing socket preservation as a therapeutic procedure following tooth extraction which includes the procedure done during or after the removal of tooth in order to reduce the risk of external ridge resorption and increase the formation of bone with the socket. This study aims to evaluate the site predilection for socket preservation in maxillary and mandibular anterior teeth following extraction. It is a retrospective study conducted by reviewing 86,000 patient case records of the Saveetha Dental College and Hospital, Chennai, India. A total of 25 consecutive case records of patients for a period of October 2019 to March 2020 with signed informed consent were selected from the Departments of Prosthodontics and Implantology based on the inclusion criteria of patients who have undergone socket preservation procedure indicated for implant placement. Information such as patient’s name, patient’s identification number (PID), age, gender and area of socket preservation were retrieved from the patients’ case records. Datas were entered in Excel and analyzed using SPSS software version 23.0. Descriptive analysis was done for the assessment of age, gender and area of socket preservation. Chi-square test was used to evaluate the association of socket preservation with age and gender. Significant level test was set at less than or equal to 0.05 (p≤0.05). In this study, higher prevalence of socket preservation was seen in the upper anterior region (60%) than the other sites. Most cases of socket preservation were seen in males (80%) as compared to females (20%). Socket preservation was done mainly in individuals within the 21-30 years age group.Within the limits of the study, socket preservation is done mainly in individuals within the 21-30 years age group with higher predilection in males compared to females. Most of the socket preservation procedures are done in the upper anterior region, followed by upper posterior, both upper anterior and posterior and lower posterior. However, there is no significant association between the area of socket preservation with age and gender.

TYPES OF OPEN APICES SEEN IN IMMATURE PERMANENT TEETH IN PEDIATRIC PATIENTS VISITING DENTAL COLLEGE

AlaguRathiBharathi .; Mebin George Mathew; M. Sivakumar

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 1762-1768

An immature permanent tooth is a newly erupted tooth with incomplete root formation. Once the tooth erupts, it takes upto three years for root completion. Any trauma or pathology to the tooth during this tooth might cause the tooth to lose its vitality. This clinical scenario is a challenge to the clinician as root does not develop further and may fracture. The present study was undertaken to evaluate the types of open apices seen in immature non vital permanent teeth. Data was retrospectively collected from the clinical records of patients who visited the Department of Pedodontics and Preventive Dentistry, from June 2019 to March 2020. 34 patients who fulfilled the inclusion and exclusion criteria were included in the study. Data was analysed using chi square test.Results showed that 27 males (79.41%) had open apices compared to females (20.59%). Non blunderbuss(55.28%) canals were more common compared to blunderbuss canals (44.12%). Within the limitations of our study, we conclude that non blunderbuss canals were found to be more common. Male patients had higher prevalence of open apices compared to females.