Can a Bullet be Dangerous without a Weapon?

Background: Blast injuries have a unique ability to cause acute harm to multiple individuals simultaneously. The severity and mechanism of injury depend on factors such as distance, released kinetic energy, material properties, affected area, and available protective measures. The resulting explosion wave can cause a range of injuries, from superficial to internal, and potentially lifethreatening. Therefore, it is crucial to promptly evaluate the patient clinically and with imaging techniques and provide immediate emergency interventions. Case Report: We present the case of a 19-year-old male who accidentally sustained blast injuries while mishandling a cartridge while attempting to cut the bullet with a hand-held circular saw. The explosion caused injuries in five anatomical regions. After receiving immediate emergency care, the patient underwent surgical intervention performed simultaneously by three surgical teams. Subsequently, he was monitored in the intensive care unit (ICU) for six days and was eventually discharged after a 13-day hospitalization. Conclusion: The natural curiosity of young individuals plays a significant role in promoting ongoing progress. However, it can sometimes lead to detrimental consequences for their well-being. Effective management by a polytrauma team becomes a race against time to preserve the patient's life and prevent disabilities.

General Health among Eastern Romanian Emergency Medicine Personnel during the Russian-Ukrainian Armed Conflict.

(1) Background: The aim of the current study is to identify the relations between worries, threat perceptions, anxiety states, and general health in a sample of Emergency unit staff during the Russian Ukrainian armed conflict. The sample consisted of 372 Emergency Care staff (M age = 39.41; 77.2% women), physicians, and nurses from North-eastern Romania. (2) Methods: Participants completed an online survey including scale measuring worries, recent anxiety symptoms, and general health. The survey was distributed and completed in the next month after the outbreak of the war. (3) Results: The results showed that the worries, perceived threats, and anxiety symptoms during the last period are negatively related to general health. Women presented higher levels of worries, perceived threats, and anxiety symptoms, compared to men, while for general health, women presented lower scores. Concerning the differences between different professional categories, the results showed that trainees presented higher scores on worries, perceived threats, and anxiety symptoms, as well as lower scores on general health. The implications of these results for improving health and quality of life are discussed. (4) Conclusions: The level of stress increases beyond the borders where the war takes place, thus indirectly affecting the Emergency Care staff involved in the care of victims. Clinical implications of these results for interventions designed to monitor quality of life and to prevent unwanted consequences of exposure to traumatic life events are discussed.

Aqueous Humor Cytokines in Non-Proliferative Diabetic Retinopathy.

Background and Objectives: Cytokines are cell-signaling proteins whose identification may serve as inflammatory markers or early indicators for progressive disease. The aim of our study was to quantify several cytokines in aqueous humor (AH) and their correlations with biochemical parameters in diabetic eyes with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: A total of 62 eyes from 62 patients were included in the study: 37 eyes from nondiabetic patients (group 1), 13 diabetic eyes with no retinopathy changes (group 2) and 12 diabetic eyes with early and moderate NPDR (group 3). AH samples were collected during uneventful cataract surgery. The cytokines IL-1ß, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, TNF-α and VEGF were quantified using multiplex bead-based immunoassay. Due to unreliable results, IL-1ß, TNF-α, IL-10 and IL-12 were excluded. Concentrations were compared between groups. Biochemical parameters (fasting blood sugar, glycated hemoglobin, C-reactive protein) and the duration of diabetes were recorded. Results: VEGF levels were significantly different between groups (p = 0.001), while levels of IL-6, IL-8, IP-10 and MCP-1 were comparable across all groups (p > 0.05). IL-6 concentration correlated with VEGF in group 1 (rho = 0.651, p = 0.003) and group 3 (rho = 0.857, p = 0.007); no correlation could be proved between IL-6, IL-8, IP-10, MCP-1 or VEGF and biochemical parameters. Duration of diabetes was not correlated with the cytokine levels in groups 2 and 3. The receiver operating characteristic (ROC) curve revealed that VEGF concentrations could discriminate early and moderate NPDR from diabetes, with an area under the curve (AUC) of 0.897 (p = 0.001, 95% CI = 0.74−1.0). Conclusions: Diabetes mellitus induces significant intraocular changes in the VEGF expression in diabetic patients vs. normal subjects, even before proliferative complications appear. VEGF was increasingly expressed once the diabetes progressed from no retinopathy to early or moderate retinopathy.

Choroidal Assessment in Patients with Type 2 Diabetes Mellitus and Non-Proliferative Diabetic Retinopathy by Swept-Source Ocular Coherence Tomography and Image Binarization.

Background and Objectives: The aim of this study was to evaluate choroidal structure and vascularity indices in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Sixty-three eyes from sixty-three patients were evaluated: 21 from healthy subjects, 20 with diabetes mellitus (DM) and no diabetic retinopathy (DR), and 22 with DM and non-proliferative diabetic retinopathy without diabetic macular edema (DME). Each patient underwent ocular examination, macular swept-source ocular coherence tomography (SS-OCT) imaging, glycemic control, and systemic high blood pressure (HBP) evaluation. Subfoveal choroidal thickness (SF-CT) was manually assessed on a line scan. Line scan OCT images were exported to ImageJ program. The areas under a 1.5, 3 and 6 mm horizontal line centered on the fovea were assessed by converting the OCT images to binary images, and total choroidal area (TCA), luminal area (LA), stromal area (SA), LA:SA ratio, and choroidal vascularity index (CVI) were evaluated. SF-CT and choroidal parameters were compared between groups, and correlations with ocular and systemic factors were analyzed. Results: SF-CT, TCA, LA, and SA were similar between groups. CVIs were significantly different between groups for all three studied areas (CVI-1.5: 66.21% vs. 66.06% vs. 63.74%, p = 0.003; CVI-3: 65.88% vs. 66.46% vs. 63.79%, p = 0.008; CVI-6: 64.79% vs. 65.40% vs. 63.61%, p = 0.032). NPDR patients had significantly lower CVIs compared to DM patients (p < 0.05). No association of choroidal parameters with glycemic control, DM duration and HBP was found significant (p < 0.05). Conclusions: Choroidal assessment by SS-OCT and image binarization in healthy subjects, subjects with DM without DR, and subjects with DM and NPDR indicated that CVI changes were identifiable and significant in early DR. The lack of association with ocular and systemic factors suggest that CVIs are reliable assessment parameters of choroidal vascular structure.