Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma: A double-blind, randomized clinical trial / 中华创伤杂志(英文版)

PURPOSE@#Patients with multiple traumas are at high risk of developing respiratory complications, including pneumonia and acute respiratory distress syndrome. Many pulmonary complications are associated with systemic inflammation and pulmonary neutrophilic infiltration. Leukotriene-receptor antagonists are anti-inflammatory and anti-oxidant drugs subsiding airway inflammation. The present study investigates the effectiveness of montelukast in reducing pulmonary complications among trauma patients.@*METHODS@#This randomized, double-blind, placebo-control trial was conducted in patients with multiple blunt traumas and evidence of lung contusion detected via CT scan. We excluded patients if they met at least one of the following conditions: < 16 years old, history of cardiopulmonary diseases or positive history of montelukast-induced hypersensitivity reactions. Patients were allocated to the treatment (10 mg of montelukast) or placebo group using permuted block randomization method. The primary measured outcome was the volume of pulmonary contusion at the end of the trial. The secondary outcomes were intensive care unit and hospital length of stay, ventilation days, multi-organ failure, and the in-hospital mortality rate.@*RESULTS@#In total, 65 eligible patients (treatment = 31, placebo = 34) were included for the final analysis. The treatment group had more pulmonary contusion volume (mean (SD), mm3) at the right (68726.97 (93656.54) vs. 59730.27 (76551.74)) and the left side (67501.71 (91514.04) vs. 46502.21 (80604.21)), higher initial C-reactive peptide level (12.16 (10.58) vs. 10.85 (17.87)) compared to the placebo group, but the differences were not statistically significant (p > 0.05). At the end of the study, the mean (SD) of pulmonary contusion volume (mm3) (right side = 116748.74 (361705.12), left side = 64522.03 (117266.17)) of the treatment group were comparable to that of the placebo group (right side = 40051.26 (64081.56), left side = 25929.12 (47417.13), p = 0.228 and 0.082, respectively). Moreover, both groups have statistically similar hospital (mean (SD), days) (10.87 (9.83) vs. 13.05 (10.12)) and intensive care unit length of stays (mean (SD), days) (7.16 (8.15) vs. 7.82 (7.48)). Of note, the frequency of the in-hospital complications (treatment vs. control group) including acute respiratory distress syndrome (12.9% vs. 8.8%, p = 0.71), pneumonia (19.4% vs. 17.6%, p = 0.85), multi-organ failure (12.9% vs. 17.6%, p = 0.58) and the mortality rate (22.6% vs. 14.7%, p = 0.41) were comparable between the groups.@*CONCLUSION@#Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.

Estudio clínico-epidemiológico de pacientes con lesiones de la columna vertebral por heridad de bala atendidos en un hospital de referencia de seguridad social / Clinical epidemilogical trial in patients who have gunshot spine injurie, admitted to a reference social security hospital

Se estudiaron 38 pacientes con lesiones de la columna vertebral por heridas de bala, 35 del sexo masculino (92 por ciento) y 3 del femenino (8 por ciento), con una edad promedio de 26 años (DE = 7), siendo los empleados los más frecuentemente afectados (24 por ciento), seguido de obreros y estudiantes en el 18 por ciento cada uno. Las lesiones se produjeron entre las 18:01 y las 24:00 horas en el 42 por ciento (16) de los casos, y entre las 12:01 a las 18:00 horas en el 31.6 por ciento (12 casos). La región anatómica más frecuentemente afectada fue la lumbar (50 por ciento), seguida de la región torácica (37 por ciento) y cervical en el 13 por ciento. A su ingreso, 15 pacientes presentaron lesión medular completa (40 por ciento), 8 pacientes con síndrome medular anterior (21 por ciento), y sólo 3 pacientes se encontraron íntegros (8 por ciento).

Síndrome de Cyriax: 54 casos y revisión de la literatura / Cyriax syndrome: 54 cases and literature review

El síndrome consiste en la subluxación del extremo distal de la 8a. y'o 10a. costillas generalmente secundario y traumatismo. Se manifiesta principalmente por el dolor abdominal alto, lo cual hace se confunda con patología visceral. El diagnóstico es clínico y debiera tenerse presente como diagnóstico diferencial evitando así múltiples exploraciones a los pacientes que lo sufren