Estimación del daño por trauma ocular en Pediatría sin la evaluación de la agudeza visual / Estimation of damage in pediatric ocular trauma without evaluating visual acuity

Introducción. La cuantificación de la agudeza visual (AV) en el niño con trauma ocular puede ser limitada. El objetivo de este estudio fue estimar si los parámetros del sistema de clasificación de lesiones mecánicas oculares (SCLMO) podrían detectar la afección visual significativa (AVS) y el daño del segmento posterior (DSP), sin evaluar la AV. Métodos. Se realizó un estudio observacional, analítico, transversal, retrospectivo y abierto. Se incluyeron niños con trauma ocular y calificación del SCLMO. Se identificaron los ojos con AVS y DSP y se compararon sus proporciones entre los parámetros del SCLMO (χ², razón de momios RM). Resultados. Se analizaron doscientos ojos de pacientes con edad promedio de 10.88 años. Los parámetros asociados con AVS fueron: globo abierto con trauma abierto tipo A (p =0.002, RM=14.14), globo con trauma abierto (p <0.001, RM=11.25), zona II (p =0.001, RM=3.17) y pupila positiva (p <0.001); los asociados con DSP: zona III (46.5%, p <0.001, RM=26.43) y globo con trauma abierto tipo A (40.0%, p=0.059, RM=3.39). Conclusiones. La AVS podría detectarse sin medir la AV en pacientes pediátricos siempre que se evalúen los parámetros restantes del SCLMO.

Background. Quantifying visual acuity (VA) can be limited in children with ocular trauma. Could the parameters of the system for classifying mechanical injuries of the eye (SCMIE) detect the eyes with significant visual affection (SVA) and damage in the posterior ocular segment (DPOS) without the need for visual acuity evaluation? Methods. An observational, analytical, cross-sectional, retrospective and open label study was conducted. Pediatric patients with uni- or bilateral eye trauma and grading using the SCMIE were evaluated. We identified eyes with SVA and those with DPOS. Their rates were then compared between the parameters of SCMIE (χ2 and odds ratio, OR). Results. Two hundred eyes were evaluated (mean age: 10.88 years). The parameters associated clinically with SVA were type A open globe (p = 0.002, OR = 14.14), open globe (p <0.001, OR = 11.25), zone II (p = 0.001, OR = 3.17) and positive pupil (p <0.001). Those associated with DPOS were zone III (46.5%, p <0.001, OR = 26.43) and type A open globe (40.0%, p = 0.059, OR = 3.39). Conclusions. Ocular trauma that causes SVA in children may be detected without measuring VA, provided that the remaining parameters of the SCMIE are evaluated.

Ocular trauma score para la evaluación inicial del trauma ocular / Ocular trauma score at the initial evaluation of ocular trauma

Introducción: El sistema de clasificación de lesiones mecánicas oculares establece el estado del ojo lesionado pero no tiene valor pronóstico. El objetivo de esta investigación fue identificar la proporción de ojos lesionados sin alteraciones que requirieron la participación del oftalmólogo durante la evaluación inicial, para saber si el ocular trauma score (que estima el pronóstico visual a los seis meses) pudiera ser empleado por médicos no oftalmólogos en la sala de trauma. Material y métodos: Con el sistema de clasificación de lesiones mecánicas oculares se evaluaron pacientes con trauma ocular atendidos en un hospital general de la ciudad de México entre 1995 y 2008. Se identificó la proporción de ojos que requería la evaluación por el oftalmólogo por desprendimiento de retina o endoftalmitis. A todos los ojos se les asignó una categoría del ocular trauma score. Se determinó la proporción y el intervalo de confianza de 95% de los ojos en que podría aplicarse el ocular trauma score en la sala de trauma. Resultados: Se evaluaron 742 ojos. Seis presentaron desprendimiento de retina (0.8%, IC 95% 0.16-1.44) y dos endoftalmitis (0.3%, IC 95% 0-0.69). La proporción de ojos en que podría aplicarse el ocular trauma score en la sala de trauma fue de 98.9% (IC 95% 98.15-99.65). Conclusiones: El ocular trauma score puede utilizarse en casi todos los ojos lesionados para estimar el pronóstico visual durante la evaluación inicial en la sala de trauma, sin la participación de un oftalmólogo.

BACKGROUND: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room. METHODS: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined. RESULTS: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65). CONCLUSIONS: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.

Evaluation of mechanical injuries in homicidal deaths: (A retrospective study of 5 years).

Jamnagar region, Gujarat state, enjoys a relatively low incidence of homicide in India. The following study examined 120 cases, (67.04%) of homicides where death was produced by inflicting various mechanical injuries on the body, reported during the years 2000 to 2004. Incidence of homicidal deaths due to mechanical injuries was 24 cases per year. It formed about 2.89% of all the total medico legal autopsies conducted during the period. Mechanical injuries were quite common in homicidal deaths involving as many as 92 male and 27 female victims. Majority of the victims were in the age group of 21 to 40 years with 77 cases, (64.17%). Blunt force was the most commonly employed method seen in 58 cases, (48.33%). It was followed by sharp force seen in 38 cases, (31.67%) and sharp and blunt combine forces seen in 23 cases, (19.17%). Incidence of fire arm injuries was quite rare in the present study. Head injury was quite common in homicide. Maximum external injuries were seen on the head and mostly they were produced by hard, blunt and heavy weapons. Stab injuries were commonly seen on the chest and abdomen. In the present study 35 cases, (29.17%) showed presence of defence wounds. Defence wounds were commonly seen in the male victims.

Medicolegal study of mechanical injuries in culpable homicides (excluding deaths due to rash and negligent act).

Trend of homicides by different means keeps on changing with the passage of time and development in different parts of the world. A study was conducted on 200 alleged cases of homicides (excluding deaths due to rash and negligent act). Different profiles from demographic and medicolegal aspects were evaluated. The incidence of homicidal deaths was observed as 12.03%, with male preponderant (82.5%) and the commonest age affected was 21 to 40 yrs (51.5%). Rural population was mainly affected. The blunt weapon (50.88%) was commonly used to inflict the injuries and 'abrasion' was the commonest manifestation (32.73%). The defence wounds were present in 36% cases. Head was the main seat of injury (13.65%). The cause of death in most cases was hemorrhage and shock (31.5%), followed by injury to brain (28.5%). Only 16% cases of these received hospital care. This necessitates the prompt medical care to be provided in the 'Golden Hour' to save valuable human life. Police patrolling for early detection of crime and shifting of injured to hospital/critical care center and provision of prompt ambulance service by state/ private hospital/ NGO's for medical care.

TNF?, ConA and mechanical injury stimulate matrix metalloproteinase-9 expression in human bronchial epithelial cell line h292 / 中国病理生理杂志

AIM: To study the expression of matrix metalloproteinase-9 (MMP-9) in human bronchial epithelial cell treated with TNF-?, ConA and mechanical injury. METHODS: RT-PCR and gelatin zymography were performed to observe the dynamic expression of matrix metalloproteinase-9(MMP-9) in human bronchial epithelial cell line H292 at different timepoint(2 h, 6 h,12 h, 24 h) after stimulation with TNF-?, ConA and mechanical injury. RESULTS: Human bronchial epithelial cell H292 expressed and secreted matrix metalloproteinase-9 in the presence of TNF-?, ConA and mechanical injury. On stimulation with mechanical injury alone, MMP-9 was initially expressed at 2 h, peaked at 12 h, and decreased at 24 h. Furthermore, on stimulation with combination of ConA and mechanical injury, the MMP-9 mRNA expression was the highest among in all the groups. Zymography show that the MMP-9 activity appeared just at 24 h timepoint, and was highest at the group of combination of ConA and mechanical injury. CONCLUTION: Human bronchial epithelial cell expressed and secreted MMP-9 when treated with TNF-?, ConA and mechanical injury.