Search Results (25)

Background/Objectives: Early diagnosis and surgical intervention are critical in upper extremity (UE) compartment syndrome to prevent irreversible muscle necrosis or amputation. Despite its prevalence, there remains limited literature guiding surgical management or predictors of complications. This study aims to characterize risk factors and outcomes following UE fasciotomies. Methods: A 14-year (2010–2024) retrospective review was conducted of adult patients undergoing fasciotomies for UE compartment syndrome at a level 1 trauma center. Exclusion criteria included age <18 years, incomplete records, or fasciotomies not performed for compartment syndrome. Data collected include demographics, injury mechanism, presenting symptoms, and diagnostic methods. Intraoperative details obtained include incision type, number of interventions, closure method, presence of muscle necrosis, and amputation. Results: Fifty-five patients (58 extremities) met the inclusion criteria (median age 42 years; 85% male). Mechanisms included fractures (29.3%), prolonged pressure (“found-down”) (25.9%), vascular injuries (13.8%), ballistic trauma (8.6%), crush (6.9%), and other (15.5%). Common symptoms were pain (72.4%), paresthesias (48.3%), and motor dysfunction (43.1%). Isolated fasciotomy incisions included volar forearm (41.4%), hand (8.6%), dorsal forearm (3.4%), and upper arm (1.7%), with the remaining being combinations thereof. Among the 40 total volar forearm fasciotomies, none developed postoperative dorsal forearm muscle necrosis. Muscle necrosis (19%) was associated with pallor (p = 0.05) and pulselessness (p < 0.001). A prolonged pressure mechanism was associated with increased muscle necrosis (p = 0.02) and amputation (p < 0.001). Meanwhile, the fracture mechanism was associated with decreased muscle necrosis (p < 0.001) and higher DPC rates (p < 0.001). Conclusions: Pain, paresthesias, and motor dysfunction were most common symptoms in UE compartment syndrome; pallor and pulselessness correlated with muscle necrosis, indicating advanced compartment syndrome. The prolonged pressure mechanism was associated with greater muscle necrosis and amputation, while fracture-related mechanisms were associated with decreased muscle necrosis and higher DPC rates. Full article

Venous access selection represents a pivotal aspect of permanent pacemaker implantation, directly influencing both procedural safety and long-term device performance. Although the subclavian vein has been traditionally favored, its use is associated with notable risks, including pneumothorax, hemothorax, and crush syndrome. In contrast, axillary access has gained prominence, supported by observational studies and a small number of randomized trials demonstrating reduced pneumothorax rates, fewer arterial punctures, and potentially fewer long-term mechanical lead failures, particularly when ultrasound guidance is used. However, these findings are derived from heterogeneous studies with variable definitions, imaging protocols and operator experience, highlighting that evidence quality remains moderate. Contemporary advances—such as routine ultrasound guidance, micropuncture techniques, and structured training—have improved procedural consistency and safety, a trend reflected in recent guidelines. This review provides a focused appraisal of complication patterns, anatomical differences and patient-specific considerations to support individualized and evidence-aligned venous access selection in modern clinical practice. Full article

Objective: The human body cannot withstand intense mechanical forces generated by an earthquake. The shaking effect of an earthquake, as the human body absorbs it, produces both visible and invisible injuries. Therefore, it is essential to provide accurate triage in the process of mass casualties. Hence, this study aims to characterize green triage patients of the 2023 Kahramanmaraş, Turkey, earthquake and emphasize the need to reconsider mass casualty triage. Methods: A retrospective cross-sectional study was conducted on green triage patients who did not receive first-aid medical attention and attended the emergency department (ED) of a tertiary care hospital. The development of crush syndrome (CS), the receipt of renal replacement therapy (RRT), and associated injuries were considered. Results: Among 295 individuals, CS occurred in 32.2%, and RRT was required in 7.1% of cases. In addition to the traditional markers of CS, non-trapped green triage patients developed both CS and required RRT, as well as sustained injuries. Whether trapped or not, CK levels emerged as a significant predictor of CS. Conclusions: Green triage patients may acquire CS even in the absence of obvious injuries or entrapment. Accurate triage can be life-saving even in the absence of obvious injuries. Full article

Background/Objectives: The co-existence of multiple compression sites on the same nerve can pose a clinical and diagnostic challenge, warranting a different treatment strategy. This so-called double crush syndrome (DCS) has mainly been investigated in the upper limb. Only a few studies have investigated DCS for the lower limb. In this article, a single-center illustrative clinical case series is presented, and current literature on L5 nerve root (NR) and concomitant common peroneal nerve (CPN) is reviewed. Methods: All patients presenting between 2019 and 2022 with L5 nerve root (NR) compression and, along their clinical courses, concomitant compression of the common peroneal nerve (CPN) at the fibular head were included. Information on clinical features, diagnostics and surgeries was obtained. The outcome was assessed at the last outpatient follow-up appointment. In addition, an extensive literature review has been conducted. Results: Fourteen patients were included with a mean follow-up of 6.8 months. The majority had pain (71%) or motor deficits (71%). Seven patients were referred for clinical and radiological L5 NR compression but were also found to have CPN compression; the other seven patients had persisting or recurrent symptoms after surgically or conservatively treated L5 NR compression, suggestive of additional peroneal neuropathy. All patients had CPN decompression at the fibular head, with successful results obtained in 93% of the patients. Pain of the lower leg improved in all patients, and dorsiflexion function improved in 78%. Conclusions: Concomitant L5 NR and CPN appear to occur more frequently than expected. Peroneal neuropathy can present simultaneously with L5 nerve radiculopathy or after surgically or conservatively treated L5 NR compression. Overlapping symptoms and variation in clinical presentations make it difficult to diagnose and, therefore, underrecognized. More awareness among treating physicians of this specific double crush syndrome is important to prevent any delay in treatment, in this case, a less invasive common peroneal nerve release at the fibular head, and to avoid unnecessary (additional) spinal surgery. Full article

Background: acute compartment syndrome (ACS) is an orthopedic emergency characterized by pathological pressure elevation within a confined anatomical space, posing a significant challenge in pediatric patients. ACS affects children in a very limited proportion, particularly involving the upper extremities, and diagnosis is complicated by subtle manifestations compared to adults. Case Presentation: we report on the case of a 5-year-old boy who sustained a crush injury to his right hand, resulting in multiple metacarpal fractures and subsequent ACS. The patient presented with severe pain, hand deformity, and restricted mobility. Radiological evaluation confirmed displaced fractures of multiple metacarpals. Emergency surgical intervention involved six incisions to decompress the dorsal and palmar compartments, release muscles, and decompress the median nerve. Healing involved delayed primary closure monitored every 72 h, resulting in an optimal outcome without complications. Conclusions: pediatric upper extremity ACS is rare, complicating diagnosis and treatment due to limited guidelines. This case underscores the effectiveness of early surgical decompression and delayed primary closure in achieving favorable outcomes. Individualized treatment strategies tailored to anatomical considerations and ACS severity are crucial to optimize patient care in pediatric surgical settings. Full article

Background/Objectives: After the earthquakes in Turkey, many citizens were injured, and a long ongoing process requiring physiological and psychological treatments began. The aim of this study was to observe the pain and psychological changes in earthquake victims in light of the QoR-15 score. Methods: After approval by the local ethics committee (Decision No. 2023-194), earthquake victims with catheters in trauma and reconstructive surgery were retrospectively evaluated. Demographic and catheterization data were collected. Baseline, 24 h, 72 h QoR-15 (Quality of Recovery-15), and VAS (Visual Analog Scala) scores were compared for changes over time. Results: A total of 40 catheters were placed in 29 patients (after the exclusion of children, 36 catheters were evaluated in 26 (15 w/11 m) patients). The mean age of the patients was 35.57 ± 13.69 years, and the duration of catheterization was 8 (4.25–12.75) days. An infusion of 0.1% bupivacaine 0.5–1 mg/kg/24 h was started routinely. The QoR-15 scores of the patients at baseline, 24 h, and 72 h were 80.45 ± 17.76, 95.27 ± 15.16, and 101.06 ± 15.52, respectively (p < 0.001). The VAS scores of the patients at baseline, 24 h, and 72 h were 4.61 ± 1.41, 1.79 ± 1.36, and 0.76 ± 0.86, respectively (p < 0.001). Conclusions: In this study, a significant improvement in QoR-15 and VAS scores was achieved as a result of catheter insertion in earthquake victims. Considering that post-traumatic injuries require repeated surgeries and that pain aggravates the existing psychological state, it can be said that catheterization is beneficial. Full article

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment. Full article

Background: The recent earthquakes that occurred in Southern Turkey on the 6th of February 2023, were the most devastating earthquakes that have occurred in Turkey in the modern era. Teams of rescuers from 19 EU states quickly responded and carried out rescue missions across the affected area. This article is a report of a case series of rescues performed by the Romanian response team RO-USAR 1, with its aim being to assess the need of an internation consensus regarding immediate first-care in patients that are victims of natural or human-made catastrophes. Operations: A total of five victims were extracted alive from under the debris by our team and transported to the nearest available hospital by ambulance. A total of eight deceased victims were also extracted to facilitate access to the aforementioned alive victims. Conclusions: Quickly recognizing life-threatening situations and rapidly instating rapid fluid resuscitation is an essential step in reducing mortality in patients affected by major natural or human-made disasters. The need for an international consensus for the prehospital care of these patients is needed now more than ever in order to further ameliorate morbidity and mortality that largely occurs due to crush syndrome and its derived complications. Full article

Crush syndrome (CS), also known as traumatic rhabdomyolysis, is a syndrome with a wide clinical spectrum; it is caused by external compression, which often occurs in earthquakes, wars, and traffic accidents, especially in large-scale disasters. Crush syndrome is the second leading cause of death after direct trauma in earthquakes. A series of clinical complications caused by crush syndrome, including hyperkalemia, myoglobinuria, and, in particular, acute kidney injury (AKI), is the main cause of death in crush syndrome. The early diagnosis of crush syndrome, the correct evaluation of its severity, and accurate predictions of a poor prognosis can provide personalized suggestions for rescuers to carry out early treatments and reduce mortality. This review summarizes various methods for the diagnostic and predictive evaluation of crush syndrome, including urine dipstick tests for a large number of victims, traditional and emerging biomarkers, imaging-assisted diagnostic methods, and developed evaluation models, with the aim of providing materials for scholars in this research field. Full article

Background and Objectives: The current study aims to determine the impact of fasciotomy on mortality and morbidity in children and adults with crush-related AKI following the 2023 Kahramanmaraş earthquakes. Materials and Methods: The study included individuals who had suffered crush injuries after the 2023 Kahramanmaraş earthquakes and were identified as having an acute kidney injury (AKI). Patients with an AKI were divided into two groups based on age: those under 18 years and those over 18 years. A comparative analysis was conducted between the mortality and morbidity rates of patients who underwent fasciotomy and those who did not. Disseminated intravascular coagulopathy (DIC), sepsis, and adult respiratory distress syndrome (ARDS) have all been identified as contributors to morbidity. Results: The study was conducted with a total of 40 patients (21 males and 19 females) aged between 4 and 83 years. A total of 21 patients underwent fasciotomy, and the patients underwent varying numbers of fasciotomy, ranging from 0 to 11. The mortality rate was 12.5%, corresponding to five adult patients. No instances of mortality were reported in the paediatric cohort. The application of fasciotomy in instances of crush-induced AKI did not result in elevated levels of mortality in either the paediatric or adult demographic. Within the adult population, a substantial difference in the duration of dialysis was observed between individuals who underwent fasciotomy and those who did not. A statistically significant increase in the number of fasciotomy incisions was observed in patients diagnosed with sepsis compared with those without sepsis. The study found a significant positive correlation between the number of fasciotomy incisions and dialysis days. Conclusions: Neither adult nor paediatric patients with crush-induced AKI showed an increased risk of death after fasciotomy. The number of fasciotomy incisions significantly correlated with the development of sepsis. Despite experiencing delays in hospital admission for paediatric patients, the incidence of both crush syndrome and mortality rates among children remained relatively low. Full article

Building collapse leads to mechanical injury, which is the main cause of injury and death, with crush syndrome as its most common complication. During the post-disaster search and rescue phase, if rescue personnel hastily remove heavy objects covering the bodies of injured individuals and fail to provide targeted medical care, ischemia-reperfusion injury may be triggered, leading to rhabdomyolysis. This may result in disseminated intravascular coagulation or acute respiratory distress syndrome, further leading to multiple organ failure, which ultimately leads to shock and death. Using bio-radar to detect vital signs and identify compression states can effectively reduce casualties during the search for missing persons behind obstacles. A time-domain ultra-wideband (UWB) bio-radar was applied for the non-contact detection of human vital sign signals behind obstacles. An echo denoising algorithm based on PSO-VMD and permutation entropy was proposed to suppress environmental noise, along with a wounded compression state recognition network based on radar-life signals. Based on training and testing using over 3000 data sets from 10 subjects in different compression states, the proposed multiscale convolutional network achieved a 92.63% identification accuracy. This outperformed SVM and 1D-CNN models by 5.30% and 6.12%, respectively, improving the casualty rescue success and post-disaster precision. Full article

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy in which one of the body’s peripheral nerves becomes pinched or crushed. Transforming growth factor beta 1 (TGF-β1) plays an important role in the pathogenesis of CTS. An association between TGF-β1 polymorphisms and the susceptibility or progression of a number of diseases has been reported. In this study, three TGF-β1 single nucleotide polymorphisms (SNPs), serum TGF-β1, and macrophage inflammatory protein 1 beta (MIP-1β) were investigated as potential diagnostic markers for the progression of CTS in Egyptian patients. One hundred CTS patients and 100 healthy controls were recruited for the study. TGF-β1 SNPs +915G/C, −509C/T and −800G/A were determined by TaqMan genotyping assay. Serum TGF-β1 and MIP-1β levels were measured by ELISA. Serum TGF-β1 and MIP-1β levels increased significantly and were strongly correlated with the occurrence of CTS. The C allele of +915G/C, the T allele of −509C/T, and the G allele of −800G/A occurred more frequently in patients from CTS than in controls. The serum levels of TGF-β1 and MIP-1β in the group of carriers of the genotypes +915G/C GC and CC, the genotype −509C/T TT and the genotype −800G/A GA and AA were significantly higher in CTS patients. TGF-β1 and its +915G/C, −509C/T, and −800G/A SNPs and MIP-1β could be useful prognostic markers for the occurrence of CTS. Full article

Dermatological ailments are a major health problem, especially when related to human immune deficiency syndrome and acquired immune deficiency. The goal of this study was to identify the medicinal plants used by the indigenous peoples of the Northwestern Himalayas to treat dermatological diseases. Several field trips were conducted in the spring and summer seasons of 2020–2021 to collect the plants of dermatological value and information about their use through open-ended semi-structured interviews (n = 53) and group discussions (n = 33). The current investigation found 64 ethnomedicinal plants belonging to 34 families commonly used to treat a variety of dermatological ailments. The main growth form was herbs (80%), followed by trees (8%) and ferns (6%). It was found that leaves (51%) were the most commonly used plant part, followed by roots and the whole plant. Wound healing was the most dominant application, with 18 plant species used, followed by skin burns cured by 11 plant species and skin boils by eight plant species. Out of the total (18%) of medicinal plants with cosmetic uses, i.e., roots of Jurinea dolomiaea, Rheum webbianum, and Rheum spiciforme were crushed into powder and mixed with turmeric, and the paste is applied topically for glowing skin. Among the various preparation methods, paste (38%) was the most common way of preparation, followed by poultice (29%) and infusion (9%). Between ethnic groups, the maximum homogeneity was between Gujjar and Bakarwal ethnic groups (23 species, 36%), followed by Gujjars and Kashmiri (14 species, 22%). Bakarwals and Gujjar people live in the same geographical location, and they graze their animals in pastures, practice extensive transhumance pastoralism, and pass through different ecological landscapes, thus having sufficient experiences with certain plants and retaining more knowledge. The species identified with the highest utilization based on the number of citations and use value included Ficus carica, Cichorium intybus, Euphorbia wallichii, Pinus wallichiana, Plantago major, Jurinea dolomiaea, and Artemisia absinthium. The findings of this study demonstrate that people who reside in the Northwestern Himalayas region still rely on medicinal plants. Full article

Orodispersible tablets (ODTs) are pharmaceutical formulations used to obtain fast therapeutic effects, usually recommended for geriatric and pediatric patients due to their improved compliance, bioavailability, ease of administration, and good palatability. This study aimed to develop ODTs with cannabidiol (CBD) phytocannabinoid extracted from Cannabis sativa used in the treatment of Lennox–Gastaut and Dravet syndromes. The tablets were obtained using an eccentric tableting machine and 9 mm punches. To develop CBD ODTs, the following parameters were varied: the Poloxamer 407 concentration (0 and 10%), the type of co-processed excipient (Prosolv^® ODT G2—PODTG2 and Prosolv^® EasyTab sp—PETsp), and the type of superdisintegrant (Croscarmellose—CCS, and Soy Polysaccharides—Emcosoy^®—EMCS), resulting in eleven formulations (O1–O11). The following dependent parameters were evaluated: friability, disintegration time, crushing strength, and the CBD dissolution at 1, 3, 5, 10, 15, and 30 min. The dependent parameters were verified according to European Pharmacopoeia (Ph. Eur.) requirements. All the tablets obtained were in accordance with quality requirements in terms of friability (less than 1%), and disintegration time (less than 180 s). The crushing strength was between 19 N and 80 N. Regarding the dissolution test, only four formulations exhibited an amount of CBD released higher than 80% at 30 min. Taking into consideration the results obtained and using the Modde 13.1 software, an optimal formulation was developed (O12), which respected the quality criteria chosen (friability 0.23%, crushing strength of 37 N, a disintegration time of 27 s, and the target amount of CBD released in 30 min of 99.3 ± 6%). Full article

Vertical transmission is a consistently discussed pathway of porcine circovirus type 2 (PCV2) and porcine circovirus type 3 (PCV3) transmission in pigs. To evaluate the presence of PCV2 and PCV3 in piglets, we collected tissue samples from 185 piglets that were crushed within the first week of life from 16 farms located in Germany and Austria. Pooled samples consisting of thymus, inguinal lymph node, myocardium, lung and spleen were examined for PCV2 and PCV3 by qPCR. Furthermore, oral fluid samples (OFS) from grow–finish pigs were collected and examined the same way. In piglets, PCV2 was highly prevalent (litters: 69.4%; piglets: 61.6%), whereas PCV3 prevalence was low (litters: 13.4%; piglets: 13.0%). In total, 72.6% and 67.2% of all collected OFS were PCV2 or PCV3 positive, respectively. Sow vaccination against PCV2 was identified as a protective factor concerning PCV2 in piglets (OR: 0.279; CI: 0.134–0.578; p < 0.001), whereas the porcine reproductive and respiratory syndrome virus (PRRSV) vaccination of sows was identified as a protective factor concerning PCV3 in piglets (OR: 0.252 CI: 0.104–0.610; p = 0.002). Our results show that PCV2, but not PCV3, is ubiquitous in suckling piglets and that early PCV3 infections might be modulated by PRRSV–PCV3 interaction. However, the ubiquitous nature of both viruses in older pigs could be confirmed. Full article