[Medical-surgical complications and their impact on patients' return to work whilst follow-up major lower-limb amputations in Hospital del Trabajador in Santiago (HTS)]. / Complicaciones médico-quirúrgicas y su impacto en el retorno laboral durante el seguimiento de pacientes con amputación mayor de extremidades inferiores en el Hospital del Trabajador de Santiago (HTS).

INTRODUCTION: The presence of different complications whilst follow-up amputee patients reaches 10-80%. The main objective of this research is to assess the impact of these in the return-to-work of lower-limb traumatic amputation cases. MATERIALS AND METHODS: A retrospective cohort research was carried out. Clinic-demographic variables information was recollected in order to assess its linkage to different medical-surgical complications and functional outcomes. Survival curves were created to evaluate the return-to-work of patients with and without complications. RESULTS: A total of 46 patients, on average aged 45.7 years old (91.3% men, 71.7% without comorbidities), were included on this research. The most frequent level of amputation was transtibial (65.2%). Residual limb pain, phantom pain, dermatological-infectious complications and painful neuroma were registered in 80.4%, 58.7%, 50% y 30.4% of the cases respectively. Half of the patients had returned to their workplace after 2years of post-surgical follow-up. The return-to-work rates were significantly lower in patients suffering from residual limb pain (p=0.0083) and from painful neuroma (p=0.0051). CONCLUSION: Complications are frequent during traumatic-amputee patients' follow-up and, some of them, may impact on the return-to-work rate.

Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report.

A woman in her 20s with a past medical history of surgical debulking of a right neck mass presented to the hospital for persistent and worsening right shoulder pain. The shoulder pain was associated with trismus and back and neck pain. A CT scan of the neck with contrast revealed post-surgical changes with increased heterotopic ossification throughout the surgical site extending to the supraclavicular soft tissues and the left sternocleidomastoid muscle, suggesting muscle ossification. A biopsy was performed, and the patient was diagnosed with myositis ossificans (MO). Initial treatment began with the administration of steroids and analgesics. She was scheduled for a follow-up with orthopedics, rheumatology, and genetics, but she was lost for follow-up. MO is a very rare medical condition usually associated with trauma, and in our patient, the symptoms started after a chiropractic adjustment.

Memory Wars: A Solution to the Conflict / Las Guerras de la Memoria: una Solución al Conflicto

Se discute la validez de la memoria disociativa en contextos forenses y las causas de las llamadas “guerras de la memoria”. Conceptos erróneos entre la psicología clínica y la psicología forense, una definición deficiente de la amnesia y las dificultades inherentes en el estudio de recuerdos traumáticos contribuyen a la persistencia de esta controversia. Particularmente en el campo de la psicología forense, el debate podría atribuirse a la falta de consenso sobre la evidencia científica. Los psicólogos necesitan establecer una base empírica para comprender mejor los mecanismos de la memoria involucrados en recordar y olvidar recuerdos traumáticos. Se esboza el Modelo de Accesibilidad Continua de la Memoria para explicar la recuperación de los diferentes grados de accesibilidad a los recuerdos autobiográficos basados en diferentes factores.(AU)

The validity of dissociative memory in forensic contexts and the causes of the so-called “memory wars” arediscussed. Misconceptions between clinical and forensic psychology, a deficient definition of amnesia, and the difficulties inherent in studying traumatic memories contribute to the persistence of this controversy. Particularly in the field of forensic psychology, the debate could be attributed to the lack of consensus on scientific evidence. Psychologists need to establish an empirical foundation to understand better the mechanisms of memory involved in remembering and forgetting traumatic memories. The Continuous Accessibility Model of Memory is outlined to explain the retrieval of the different degrees of accessibility to autobiographical memories based on different factors.(AU)

Traumatismo anorrectal contuso. Reporte de un caso y revisión bibliográfica / Blunt anorectal trauma. Case reportand literature review

Introducción: El traumatismo anorrectal es una causa poco frecuente de consulta al servicio de emergencias, con una incidencia del 1 al 3%. A menudo está asociado a lesiones potencialmente mortales, por esta razón, es fundamental conocer los principios de diagnóstico y tratamiento, así como los protocolos de atención inicial de los pacientes politraumatizados. Método: Reportamos el caso de un paciente masculino de 47 años con trauma anorrectal contuso con compromiso del esfínter anal interno y externo, tratado con reparación primaria del complejo esfinteriano con técnica de overlapping, rafia de la mucosa, submucosa y muscular del recto. A los 12 meses presenta buena evolución sin incontinencia anal. Conclusión: El tratamiento del trauma rectal, basado en el dogma de las 4 D (desbridamiento, derivación fecal, drenaje presacro, lavado distal) fue exitoso. La técnica de overlapping para la lesión esfinteriana fue simple y efectiva para la reconstrucción anatómica y funcional. (AU)

Introduction: Anorectal trauma is a rare cause of consultation to the Emergency Department, with an incidence of 1 to 3%. It is often associated with life-threatening injuries, so it is essential to know the principles of diagnosis and treatment, as well as the initial care protocols for the polytrau-matized patient. Methods: We present the case of a 47-year-old man with a blunt anorectal trauma involving the internal and external anal sphincter, treated with primary overlapping repair of the sphincter complex and suturing of the rectal wall. At 12 months the patient presents good outcome, without anal incontinence. Conclusion: The treatment of rectal trauma, based on the 4 D ́s dogma (debridement, fecal diversion, presacral drainage, distal rectal washout lavage) was successful. Repair of the overlapping sphincter injury was simple and effective for anatomical and functional reconstruction. (AU)

An effective insulin infusion protocol for severe traumatic brain injury patients: A retrospective observational study.

PURPOSE: Severe traumatic brain injury (sTBI) patients often experience stress hyperglycaemia, which can lead to negative outcomes. This study aims to introduce an effective insulin infusion protocol specifically designed for sTBI patients. METHODS: Data was collected from all sTBI patients during two periods: 1 October 2019 to 30 April 2020, and 1 June 2020 to 31 December 2020. In May 2020, a new insulin infusion protocol was implemented. Blood glucose management, infection, coagulation, and prognosis were compared in these two periods. RESULT: 195 patients were included, with 106 using the new protocol. The proportion of hyperglycaemia decreased from 40.04% to 26.91% (P<0.05), and the proportion of on-target blood glucose levels increased from 35.69% to 38.98% (P<0.05). Average blood glucose levels decreased from 9.98±2.79mmol/L to 8.96±2.82mmol/L (P<0.05). There was no substantial increase in hypoglycaemia, which remained controlled below 1%. The new protocol positively influenced glucose concentration and dispersion trends. There were no significant differences in catheter-related infections, antibiotic use, mechanical ventilation (MV) duration, length of stay in ICU, Glasgow Outcome Scale (GOS), or mortality. However, the conventional protocol group had a higher coagulation tendency (R-value of thromboelastography 4.80±1.35min vs. 5.52±1.87min, P<0.05), with no difference in deep vein thrombosis (DVT) incidence. CONCLUSION: Our findings suggest that a customized insulin infusion process for sTBI patients can effectively manage blood glucose. While there is no significant improvement in infection control or prognosis, it may have a positive impact on coagulation without affecting the occurrence of DVT.

Evolución neurológica en la lesión medular traumática en función del tamaño de la hemorragia intraparenquimatosa / Neurological evolution in traumatic spinal cord injury according to the size of the intraparenchymal hemorrhage

Introducción y objetivos: La presencia de hemorragia medular es considerada como un factor de mal pronóstico evolutivo en el estudio de la lesión medular traumática (LMT). No obstante, se ha sugerido en trabajos publicados que el pronóstico de los sangrados de menor tamaño no es tan negativo. El objetivo del presente trabajo es valorar la evolución neurológica en individuos con hemorragia intraparenquimatosa en función del tamaño de la misma. Material y métodos: Estudio observacional retrospectivo. Recopilados los pacientes ingresados por LMT aguda con estudio de resonancia, que objetivase una hemorragia medular entre los años 2010 y 2018. Se establecieron 2 grupos en función del tamaño del sangrado: microhemorragias (menor de 4mm) y macrohemorragias (superior a 4mm). Se comparó la exploración neurológica al ingreso y al alta atendiendo al grado AIS y el índice motor (IM). Resultados: Recogidos 46 casos, 17 microhemorragias y 29 macrohemorragias. El 70,6% de las primeras eran AIS A mientras que entre las macrohemorragias el porcentaje era del 89,6%. Al momento del alta se apreció una mejoría del grado AIS en el 40,0% de las microhemorragias por un 4,0% de las macrohemorragias (p=0,008). El IM inicial fue muy similar, 45,2±22,2 en las microhemorragias y 40,9±20,4 en las mayores (p=0,459), pero al alta era superior en el primer grupo: 60,4±20,5 por 42,7±22,8 (p=0,033). Ocho pacientes (17,4%) fallecieron durante el ingreso. Conclusiones: Existe relación entre el tamaño de la hemorragia intraparenquimatosa y el pronóstico neurológico de la LMT, presentando una mejor evolución las hemorragias menores de 4mm.(AU)

Introduction and objectives: The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size. Material and methods: Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4mm) and macrohemorrhages (greater than 4mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS). Results: Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2±22.2 in the microhemorrhages and 40.9±20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4±20.5 for 42.7±22.8 (P=.033). Eight patients (17.4%) died during admission. Conclusions: There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4mm presenting a better evolution.(AU)

Consecuencias psicológicas de las amputaciones por accidente laboral / Psychological consequences of amputations in work accidents

Fundamentos: Las amputaciones en accidente laboral son un fenómeno con gran incidencia y características peculiares. Los escasos estudios que abordan los efectos de la amputación se refieren a grandes extremidades y muestran que, más allá de las secuelas físicas, existen consecuencias importantes a nivel psicológico. El objetivo de este artículo fue mostrar el conocimiento actualizado sobre las principales consecuencias psicopatológicas de las amputaciones por accidente laboral y de las variables que pueden modularlas. Métodos: Se llevó a cabo una revisión bibliográfica de carácter no sistemático, con búsquedas variadas ad hoc para las distintas variables estudiadas. Resultados: Los estudios se han centrado principalmente en la sintomatología ansiosa y depresiva, el trastorno de estrés postraumático y el dolor del miembro fantasma. También se han identificado variables moduladoras que mejoran el pronóstico: adaptación a la vida cotidiana, ejercicio físico, estrategias de afrontamiento, resiliencia y calidad de vida. Conclusiones: Las distintas áreas psicológicas afectadas revisadas deben considerarse al acompañar a las personas con amputación por accidente laboral. Asimismo, potenciar las variables moduladoras cuya presencia mejora el pronóstico es un campo interesante para la intervención profesional.(AU)

Background: Amputations in work accidents are a phenomenon with a high incidence and peculiar characteristics. The few studies about the effects of amputation are referred to large limbs, and show that, beyond the physical consequences, there are important psychological consequences. The goal of this paper was to show the updated knowledge on the main psychopathological consequences of amputations in work accidents, as well as the variables that can modulate them. Methods: A non-systematic bibliographic review was carried out, with varied ad hoc searches for the different variables studied. Results: Studies have focused mainly on anxiety and depressive symptoms, post-traumatic stress disorder, and phantom limb pain. Modulating variables whose presence improves the prognosis of these persons have been identified, such as adaptation to daily life, physical exercise, coping strategies, resilience and quality of life. Conclusions: The different psychological areas reviewed should be considered when attending people who have suffered an amputation in a work accident. Likewise, enhancing the modulating variables whose presence improves the prognosis is an interes-ting field for professional intervention.(AU)

Tranexamic acid in patients with traumatic brain injury: a meta-analysis.

BACKGROUND: We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI). METHODS: We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval. RESULTS: In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD -2.45; 95% CI = -4.78 to -0.12; p=0.04) and less total haematoma expansion (MD - 2.52; 95% CI = -4.85 to -0.19; p=0.03) compared to controls. There were no statistically significant differences in mortality (OR 0.94; 95% CI=0.85-1.03; p=0.18), presence of progressive haemorrhage (OR 0.75; 95% CI=0.56-1.01; p=0.06), need for neurosurgery (OR 1.15; 95% CI=0.66-1.98; p=0.63), high Disability Rating Scale score (OR 0.90; 95% CI=0.56-1.45; p=0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI=0.33-5.46; p=0.68) between TBI patients treated with TXA and controls. CONCLUSIONS: Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.

'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure.

Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.

Parents of teenagers exposed to traumatic events struggle to understand trauma and feel isolated.Parents feel pressured to resume life as it was before, leading to conflictual child­parent interaction.Psychoeducation, stigma, and school involvement could be early intervention targets.

[Neurological evolution in traumatic spinal cord injury according to the size of the intraparenchymal hemorrhage]. / Evolución neurológica en la lesión medular traumática en función del tamaño de la hemorragia intraparenquimatosa.

INTRODUCTION AND OBJECTIVES: The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size. MATERIAL AND METHODS: Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4mm) and macrohemorrhages (greater than 4mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS). RESULTS: Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2±22.2 in the microhemorrhages and 40.9±20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4±20.5 for 42.7±22.8 (P=.033). Eight patients (17.4%) died during admission. CONCLUSIONS: There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4mm presenting a better evolution.

To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011.

Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.

Young adults who experience the traumatic loss of a close friend may experience levels of grief reactions indicating complicated grief.The need for help reported after experiencing the loss of a close friend is high; this is also the case when some time has passed since the loss.Bereaved friends need more acknowledgement, and help measures after traumatic events often do not meet their need for help and follow-up after the loss.

Características del trauma ocular en pacientes diagnosticados con catarata traumática / Characteristics of Ocular Trauma in Patients Diagnosed with Traumatic Cataract

Objetivo: Determinar las características del trauma ocular en pacientes diagnosticados con catarata traumática. Métodos: Se realizó un estudio observacional descriptivo de corte transversal con 335 pacientes diagnosticados con catarata traumática. Las variables incluyeron edad, sexo, ojo afectado, lugar de ocurrencia del trauma, uso de protección en el entorno laboral, tipo de trauma ocular, daños asociados, morfología de la catarata y zona de lesión. Resultados: La edad promedio de los pacientes fue de 52,2 ± 14,8 años. Se observó un predominio del sexo masculino (75,5 por ciento) y la mayoría de los casos presentaron un trauma ocular cerrado (70,4 por ciento). El ojo derecho fue más afectado (64,8 por ciento). En cuanto al lugar de ocurrencia del traumatismo ocular, el 49,9 por ciento de los casos se produjo en el contexto laboral, y la mayoría de los pacientes que experimentaron un trauma ocular abierto no utilizaban protección ocular. Las lesiones asociadas más comunes fueron el aumento de la presión intraocular, la ruptura de la cápsula y las sinequias, la diálisis del iris. En cuanto a la morfología de las cataratas, se observó que predominaba la opacidad total. Conclusiones: Este estudio subraya la importancia de estrategias preventivas, especialmente en entornos laborales propensos a lesiones oculares. La falta de protección ocular en casos de trauma ocular abierto enfatiza la necesidad de concienciar a la población sobre la importancia de medidas de seguridad adecuadas. Estos hallazgos pueden guiar intervenciones clínicas y políticas de salud pública para reducir la incidencia y las secuelas de la catarata traumática(AU)

Objective: Determine the characteristics of ocular trauma in patients diagnosed with traumatic cataract. Methods: A cross-sectional descriptive observational study was carried out with 335 patients diagnosed with traumatic cataract. The variables included age, sex, affected eye, location of trauma occurrence, use of protection in the work environment, type of ocular trauma, associated damage, cataract morphology and area of injury. Results: The average age of the patients was 52.2 ± 14.8 years. A predominance of males was observed (75.5 percent) and the majority of cases presented blunt ocular trauma (70.4 percent). The right eye was more affected (64.8 percent). Regarding the place of occurrence of ocular trauma, 49.9 percent of cases occurred in the work context, and the majority of patients who experienced open ocular trauma did not use eye protection. The most common associated injuries were increased intraocular pressure, capsule rupture and synechiae, iris dialysis. Regarding the morphology of the cataracts, it was observed that total opacity predominated. Conclusions: This study highlights the importance of preventive strategies, especially in work environments prone to eye injuries. The lack of eye protection in cases of open eye trauma emphasizes the need to raise public awareness about the importance of adequate safety measures. These findings may guide clinical interventions and public health policies to reduce the incidence and sequelae of traumatic cataract(AU)

Retinopatia de purtscher: relato de caso / Purtsher retinopathy: case report

Introdução: A retinopatia de Purtscher é uma condição clínica rara, definida pela perda súbita e severa da visão, após compressão em áreas do tórax, cabeça, fraturas em ossos longos ou lesão por esmagamento. O quadro está associado a múltiplas manchas de retina branca, geralmente acompanhadas de hemorragia e edema de disco. Por isso, a visão pode ser perdida definitivamente e a atrofia óptica se desenvolver. Objetivo: Apresentar e discutir um caso clínico de Retinopatia de Purtscher a partir de dados obtidos no prontuário clínico do paciente, especialmente em exames de imagem. Material e Método: Paciente do sexo feminino, vítima de Traumatismo Cranio Encefálico por acidente automobilístico com posterior perda da acuidade visual. Foram analisados os exames de Retinografia colorida e Tomografia de Coerência Óptica, que contribuíram para o desfecho do diagnóstico da doença. Resultados: A paciente foi submetida a tratamento medicamentoso sob acompanhamento do oftalmologista, com complemento de uma Ressonância Magnética de crânio, porém, a mesma evoluiu com pouca melhora da acuidade visual, além de parestesia persistente na região periorbital direita, ao final do tratamento. Conclusão: Apesar de melhoras aparentes nos exames de imagem, a fisiopatologia isquêmica da lesão provocou um quadro clínico irreversível

Introduction: Purtscher retinopathy is a rare clinical condition, defined by sudden and severe loss of vision, following compression in areas of the chest, head, long bone fractures or crush injury. The condition is associated with multiple patches of white retina, generally accompanied by hemorrhage and disc edema. Therefore, optic atrophy develops and vision can be permanently lost. Objective: To present and discuss a clinical case of Purtscher Retinopathy based on data obtained from the patient's clinical records, especially from imaging exams. Material and Method: Female patient, victim of traumatic brain injury due to a car accident with subsequent loss of visual acuity. Color retinography and optical coherence tomography exams were analyzed, which contributed to the diagnosis of the disease. Results: The patient underwent drug treatment under the supervision of an ophthalmologist, with the addition of a MRI of the skull, however, she evolved with little improvement in visual acuity, in addition to persistent paresthesia in the right periorbital region, at the end of treatment. Conclusion: Despite apparent improvements on imaging exams, the ischemic pathophysiology of the lesion caused an irreversible clinical condition

Introducción: La retinopatía de Purtscher es una condición clínica poco común, definida por la pérdida repentina y severa de la visión, luego de compresión en áreas del tórax, cabeza, fracturas de huesos largos o lesión por aplastamiento. La afección se asocia con múltiples manchas de retina blanca, generalmente acompañadas de hemorragia y edema discal. Por lo tanto, se desarrolla atrofia óptica y la visión puede perderse permanentemente. Objetivo: Presentar y discutir un caso clínico de Retinopatía de Purtscher a partir de los datos obtenidos de la historia clínica del paciente, especialmente de los exámenes de imagen. Material y Método: Paciente mujer, víctima de traumatismo craneoencefálico por accidente automovilístico con posterior pérdida de agudeza visual. Se analizaron exámenes de retinografía color y tomografía de coherencia óptica, que contribuyeron al diagnóstico de la enfermedad. Resultados: La paciente siguió tratamiento farmacológico bajo supervisión de un oftalmólogo, con el agregado de una resonancia magnética de cráneo, sin embargo, evolucionó con poca mejoría en la agudeza visual, además de parestesias persistentes en la región periorbitaria derecha, al final del tratamiento. Conclusión: A pesar de las aparentes mejoras en los exámenes de imagen, la fisiopatología isquémica de la lesión provocó una condición clínica irreversible

¿Existe el duelo complicado traumático? Diferencias sintomatológicas entre el duelo complicado tras una muerte traumática y una no traumática / Is there a traumatic complicated grief? Symptomatological differences between complicated grief after a traumatic and a non-traumatic death

Objetivo: Examinar la existencia del duelo complicado traumático como un constructo diferente al de duelo complicado analizando si la sintomatología de duelo complicado y de estrés postraumático es diferente en las personas que sufren duelo complicado tras una muerte traumática y no traumática. Método: Un grupo de 89 dolientes con duelo complicado tras una muerte por atentado terrorista y un grupo de 54 dolientes con duelo complicado tras una muerte por edad o enfermedad completaron el Inventario de Duelo Complicado (IDC) y versiones de la Escala de Verificación del Trastorno de Estrés Postraumático (PCL-S o PCL-5). Resultados: ANCOVA realizados sobre las puntuaciones en los ítems del IDC y en los 16 ítems comunes a las dos versiones de la PCL revelaron que los dos grupos de dolientes no diferían en ninguno de los síntomas de duelo complicado ni de estrés postraumático, salvo en dos síntomas de duelo complicado en los cuales las diferencias iban en direcciones opuestas. Conclusiones: Aunque una muerte traumática como, por ejemplo, por atentado terrorista, incrementa la gravedad de las reacciones de duelo y la probabilidad de sufrir duelo complicado, este duelo complicado es similar al que pueden sufrir las personas tras una muerte no traumática, al menos respecto a sus síntomas y a los síntomas simultáneos de estrés postraumático. Por tanto, no se puede hablar de un duelo complicado traumático como diferente al duelo complicado (AU)

Objective: To examine the existence of complicated traumatic grief as a different construct from complicated grief, analyzing whether the symptoms of complicated grief and post-traumatic stress are different in people who suffer complicated grief after a traumatic and non-traumatic death. Method: A group of 89 mourners with complicated grief after a death from a terrorist attack and a group of 54 mourners with complicated grief after a death due to age or illness completed the Inventory of Complicated Grief (ICG) and versions of the PTSD Checklist Scale (PCL-S or PCL-5). Results: ANCOVA performed on the scores on the IDC items and on the 16 items common to the two versions of the PCL revealed that the two groups of mourners did not differ in any of the symptoms of complicated grief or post-traumatic stress, except in two complicated grief symptoms in which the differences went in opposite directions. Conclusions: Although a traumatic death, such as a terrorist attack, increases the severity of grief reactions and the probability of suffering complicated grief, this complicated grief is similar to what people can suffer after a non-traumatic death, at least concerning its symptoms and the simultaneous symptoms of post-traumatic stress. Therefore, one cannot speak of complicated traumatic grief as different from complicated grief (AU)

Desgarro agudo del esfínter anal postparto con reparación inmediata / Immediate repair of acute postpartum anal sphincter tear: case report

Las lesiones obstétricas del esfínter anal pueden ocurrir durante el parto vaginal espontáneamente o secundariamente a la episiotomía. Su riesgo se estima en un 26% y son la causa más frecuente de incontinencia anal en mujeres jóvenes. Las lesiones de grado 4 de Sultan, también llamadas cloaca traumática, implican la ruptura completa del esfínter y la comunicación de la cavidad vaginal con el canal anal. La reparación es siempre quirúrgica, para lo que se han descrito diferentes técnicas, aunque ninguna ha demostrado ser superior. Presentamos el caso de una paciente primípara de 23 años con una cloaca traumática posparto. La reparación quirúrgica se realizó de inmediato con una técnica de overlapping. El postoperatorio fue sin complicaciones y al año presenta continencia anal completa. (AU)

Obstetric anal sphincter injuries can occur spontaneously or as a consequence of an episiotomy during vaginal delivery. Their risk is estimated at 26% and they are the most frequent cause of anal incontinence in young women. Sultan grade 4 injuries, also called traumatic cloaca, involve complete rupture of the sphincter and communication of the vaginal cavity with the anal canal. The repair is always surgical, for which different techniques have been described, although none have proven to be superior. We present the case of a 23-year-old primiparous patient with a postpartum traumatic cloaca. Surgical repair was performed immediately with an overlapping technique. The postoperative period was without complications and one year later she presents complete anal continence. (AU)

Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation.

Background: Racial discrimination is a traumatic stressor that increases the risk for posttraumatic stress disorder (PTSD), but mechanisms to explain this relationship remain unclear. Peritraumatic dissociation, the complex process of disorientation, depersonalization, and derealization during a trauma, has been a consistent predictor of PTSD. Experiences of frequent racial discrimination may increase the propensity for peritraumatic dissociation in the context of new traumatic experiences and contribute to PTSD symptoms. However, the role of peritraumatic dissociation in the relationship between experiences of discrimination and PTSD has not been specifically explored.Objective: The current study investigated the role of peritraumatic dissociation in the impact of racial discrimination on PTSD symptoms after a traumatic injury, and the moderating role of gender.Method: One hundred and thirteen Black/African American individuals were recruited from the Emergency Department at a Level I Trauma Center. Two weeks after the trauma, participants self-reported their experiences with racial discrimination and peritraumatic dissociation. At the six-month follow-up appointment, individuals underwent a clinical assessment of their PTSD symptoms.Results: Results of longitudinal mediation analyses showed that peritraumatic dissociation significantly mediated the effect of racial discrimination on PTSD symptoms, after controlling for age and lifetime trauma exposure. A secondary analysis was conducted to examine the moderating role of gender. Gender was not a significant moderator in the model.Conclusions: Findings show that racial discrimination functions as a stressor that impacts how individuals respond to other traumatic events. The novel results suggest a mechanism that explains the relationship between racial discrimination and PTSD symptoms. These findings highlight the need for community spaces where Black Americans can process racial trauma and reduce the propensity to detach from daily, painful realities. Results also show that clinical intervention post-trauma must consider Black Americans' experiences with racial discrimination.

Peritraumatic dissociation operates as a mechanism through which racial discrimination predicts posttraumatic symptoms in an adult trauma sample.Racial discrimination functions as a stressor that increases the risk for trauma-related symptoms.The lived experiences of Black Americans elicit the use of emotional detachment strategies that may mitigate effects of racial discrimination but increase the risk for peritraumatic dissociation.

Brain glucose metabolism and gray matter volume in retired professional soccer players: a cross-sectional [18F]FDG-PET/MRI study / Metabolismo glicolítico cerebral e volume de substância cinzenta em jogadores de futebol profissionais aposentados: um estudo transversal de [18F]FDG-PET/RM

Abstract Background Professional soccer athletes are exposed to repetitive head impacts and are at risk of developing chronic traumatic encephalopathy. Objective To evaluate regional brain glucose metabolism (rBGM) and gray matter (GM) volume in retired soccer players (RSPs). Methods Male RSPs and age and sex-matched controls prospectively enrolled between 2017 and 2019 underwent neurological and neuropsychological evaluations, brain MRI and [18F]FDG-PET in a 3.0-Tesla PET/MRI scanner. Visual analysis was performed by a blinded neuroradiologist and a blinded nuclear physician. Regional brain glucose metabolism and GM volume were assessed using SPM8 software. Groups were compared using appropriate statistical tests available at SPM8 and R. Results Nineteen RSPs (median [IQR]: 62 [50-64.5] years old) and 20 controls (60 [48-73] years old) were included. Retired soccer players performed worse on mini-mental state examination, digit span, clock drawing, phonemic and semantic verbal fluency tests, and had reduced rBGM in the left temporal pole (pFDR = 0.008) and the anterior left middle temporal gyrus (pFDR = 0.043). Semantic verbal fluency correlated with rBGM in the right hippocampus, left temporal pole, and posterior left middle temporal gyrus (p ≤ 0.042). Cray matter volume reduction was observed in similar anatomic regions but was less extensive and did not survive correction for multiple comparisons (pFDR ≥ 0.085). Individual [18F]FDG-PET visual analysis revealed seven RSPs with overt hypometabolism in the medial and lateral temporal lobes, frontal lobes, and temporoparietal regions. Retired soccer players had a higher prevalence of septum pellucidum abnormalities on MRI. Conclusion Retired soccer players had reduced rBCM and CM volume in the temporal lobes and septum pellucidum abnormalities, findings possibly related to repetitive head impacts.

Resumo Antecedentes Jogadores profissionais de futebol estão expostos a impactos cranianos repetitivos e ao risco de desenvolver encefalopatia traumática crônica. Objetivo Avaliar o metabolismo glicolítico cerebral regional (MCCr) e o volume de substância cinzenta (vSC) em jogadores de futebol aposentados (JFAs). Métodos Jogadores de futebol aposentados masculinos e controles pareados por idade e sexo foram incluídos prospectivamente entre 2017 e 2019. Foram realizadas avaliações neurológica e neuropsicológica, ressonância magnética (RM) e [18F]FDG-PET cerebrais (3.0-Tesla PET/RM). As imagens foram analisadas visualmente por um neurorradiologista e um médico nuclear cegos ao grupo de cada participante. O metabolismo glicolítico cerebral regional e o vSC foram avaliados através do programa SPM8. Os grupos foram comparados através de testes estatísticos apropriados disponíveis em SPM8 e R, de acordo com a distribuição e o tipo dos dados. Resultados Dezenove JFAs (mediana [IIQ]: 62 [50-64.5] anos) e 20 controles (60 [48-73] anos) foram incluídos. Os JFAs tiveram pior desempenho no mini-exame do estado mental e nos testes de dígitos, desenho do relógio, fluência verbal e fluência semântica e apresentaram MCCr significativamente reduzido no polo temporal e no giro temporal médio anterior esquerdos. Fluência semântica (animais) apresentou correlação positiva com MCCr no hipocampo direito, no polo temporal esquerdo e no aspecto posterior do giro temporal médio esquerdo. Menor vSC foi observado nas mesmas regiões, porém este achado não sobreviveu à correção para comparações múltiplas. Análise individual do [18F]FDG-PET cerebral revelou sete JFAs com claro hipometabolismo nas faces medial e lateral dos lobos temporais, nos lobos frontais e nas regiões temporoparietais. Os JFAs apresentaram ainda maior prevalência de anormalidades do septo pelúcido. Conclusão Os JFAs apresentam MCCr e vSC reduzidos nos lobos temporais, além de anormalidades do septo pelúcido, achados possivelmente relacionados a impactos cranianos repetitivos.

Warning signals? An explorative study of distant recollections of the moments before a disaster.

Background: How do we remember what happened shortly before a traumatic experience? There has been little focus on the temporal context of trauma memories, but a few studies suggest that aspects of what happened in the moments prior to a traumatic experience may be selectively enhanced and prioritized in memory.Objective: The main aim of this study was to investigate the occurrence, nature, and content of voluntary memories about what happened shortly before a disaster. The participants were individuals who had survived a fire on the passenger ferry Scandinavian Star 26 years earlier.Methods: Data collection took the form of face-to-face interviews. The analysis was carried out in two steps. First, all the narratives from participants who were aged 7 years or older at the time of the fire (N = 86) were coded in terms of the presence of detailed descriptions of what happened before the fire. Next, the narratives that included detailed descriptions of the moments before (N = 28) were included in a thematic analysis, focusing on coding the mode and the content.Results: More than one-third of the participants reported detailed accounts of what happened in the hours, minutes, or seconds before the fire. These memories included detailed descriptions of sensory impressions, dialogues, actions, and thoughts. Two themes stood out in the thematic analysis: (1) unusual observations and danger cues; and (2) counterfactual thoughts.Conclusion: The finding that specific details from the moments before a traumatic event may be vividly recalled indicates that peripheral details of traumatic events can be prioritized in memory. Such details may be interpreted as warning signals. Future research should examine whether such memories might stimulate long-standing thoughts of the world as being dangerous, and hence carry the threat forward in time.

A qualitative study exploring the occurrence, nature, and content of memories about what happened shortly before a disaster.For some trauma survivors, experiences or observations shortly before a traumatic event can be vividly recalled in detail, after more than two decades.Such detailed memories of what happened before a traumatic experience may be interpreted as warning signals; furthermore, they may stimulate long-standing thoughts of the world as dangerous, thus carrying the threat forward in time.

A rare femoral heterotopic bone formation in a 14th-19th century female skeleton from Constância (Portugal).

OBJECTIVE: This paper aims to: (1) document a rare femoral heterotopic ossification (HO), and (2) discuss its aetiology and impact on the individual's locomotion and daily living activities. MATERIALS: Adult female skeleton (SG.14-SK.7) from the village of Constância (Portugal), and dated from the 14th-19th centuries CE. METHODS: The biological profile and the macroscopic analysis of the bone changes were assessed using standardized methods. RESULTS: The macroscopic analysis revealed a large bony mass (8 cm length) located immediately inferior to the small trochanter of the right femur. The lesion exhibited a compact, tubular appearance located at the site of attachment of the pectineus muscle. No signs of bone fracture were observed. CONCLUSIONS: The morphology of the SG.14-SK.7 femoral lesion is compatible with a probable case of myositis ossificans traumatica (MOT), secondary to acute trauma of the pectineus muscle. The underlying trauma episode, such as random accidental and/or occupation-related injury, is unknown. However, it is highly possible that this self-limiting condition significantly impaired the individual's daily life and mobility. SIGNIFICANCE: Evidence of severe acute muscle trauma is a rare finding compared with HO secondary to bone trauma and other minor muscle injuries. Moreover, no cases of MOT affecting the pectineus muscle have been reported in the paleopathological literature to date. LIMITATIONS: Although unlikely, a case of neurogenic or burn-related HO cannot be completely disregarded. It was not possible to undertake radiography as part of this study. SUGGESTIONS FOR FURTHER RESEARCH: The use of imaging techniques to complement the paleopathological description is advised.

Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.