Epidemiology of Limb Injuries in paediatric patients receiving care from Emergency Medical Service teams: descriptive analysys

INTRODUCTION: Injury-related interventions currently place a heavy workload on emergency medical teams in both adults and paediatric patients. One of the most common types of injuries are limb injuries caused by physical activity, falls or traffic accidents. It is extremely important to provide adequate protection for the paediatric patient in case of injury, as homeostasis disorders can occur very quickly in this age group. The aim of the study was to obtain data on the type and frequency of limb injuries in the group of paediatric patients who received medical rescue services interventions. An attempt was also made to specify the most frequent causes of limb injuries. MATERIAL AND MeTHODS: The study was based on a retrospective analysis of medical records of emergency rescue teams in the period from November 2017 to October 2018. The study included an analysis of interventions to patients under 18 years of age to whom EMS teams intervened due to limb injury. The analysis included sociodemographic data such as age, gender, time and place of the injury, as well as the type of injury based on the ICD-10 classification. RESULTS: In the studied period, 289 interventions in paediatric patients with limb injuries were recorded, which constituted 9.8% of all interventions in paediatric patients. The main site of the injury was a school. Upper limb injuries were reported in 123 cases, which constituted 42.6% of the intervention to the studied group of patients. The upper limb injuries were predominantly caused by forearm fractures (n = 33; Tab. 3), while the lower limb — by knee joint injuries. CONCLUSIONS: Limb injuries account for nearly 10% of all EMS interventions in paediatric patients. The main site of the injury was a school and the most frequent were upper limb injuries including forearm fractures, while for the lower limb — knee joint injuries. Further action should be taken to reduce the number of limb injuries in children

Effector and memory CD4+ and CD8+ T cells in the chronic infection process.

T cell memory in comparison with B cell memory is not well understood. This review focuses on CD8+ and CD4+ memory T cells. In this article we try to define memory cells and also present models of memory T cells formation. We would also like to delineate their differentiation into distinct subsets. Long-lived memory T cells consist in two main subsets: TCM and TEM. Recent studies have shown that not all cells considered to be memory cells differentiate into TCM and TEM, but a small proportion of theses cells exhibit naive cells phenotype. Memory T cells constitute a heterogeneous population of cells. In this study we lay stress on characteristic of main memory T cells subsets and their alleged participation in immune response upon reexposure to the Ag

The inflammatory reaction during chronic venous disease of lower limbs.

Chronic venous disease (CVD) is an insufficiency of distal veins caused by their partial or total obstruction, endothelial distension and functional disorders. Chronic venous disease of lower limbs is common problem and affects millions of people. In this article we suggest that inflammatory process is involved in the structural remodeling in venous valves and in the venous wall, leading to valvular incompetence and the development of varicose veins

Evaluation of the memory CD4+ and CD8+ T cells homeostasis during chronic venous disease of lower limbs.

More and more is known about the role of venous wall abnormalities and valvular incompetence in the development of chronic venous disorders (CVD). Unfortunately detailed mechanisms of CVD pathophysiology are not well understood. Recent studies focus on involvement of the inflammatory process in the structural remodeling of venous valves and venous wall. The aim of this study is to investigate and to document the memory T cells homeostasis in CVD patients. In this study we present lymphocytic changes in blood from varicose veins in terms of total CD4+ and CD8+ T cells and their particular subsets of memory T cells: TN, TCM and TEM. Results suggest that immunological memory may be involved in the CVD development

Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials

Background: Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions  including adverse events. Methods: This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4. Results: Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51–0.66; p < 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59–0.83; p < 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%). Conclusions: This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings

Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials

Background: Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock. Methods: We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models. Results: Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (NS) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97–1.45; I2 = 48%; p = 0.09). 28- to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (NS) — 71.4% (OR = 1.13; 95% CI 0.75–1.70; I2 = 43%; p = 0.56). Conclusions: This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28- to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid

Retrospective analysis of thoracic trauma and evaluation of the factors affecting the duration of stay in the hospital

Background: The aim of this study is to evaluate the epidemiological and demographic features, treatment types of patients with thoracic trauma, as well as the duration of hospital stay and the factors affecting mortality.   Material and Methods: This retrospective cross-sectional study included patients who applied to the emergency room in a tertiary care hospital, between 2017–2019 and having thoracic trauma. Patients; age, gender, date of application, type of injury (blunt or penetran), arrival saturation, use of anticoagulants, type of injury, side of injury (right, left, bilateral) additional injury, hospitalization and mortality status were recorded. P < 0.05 was considered as statistically significant.   Results: Total of 113 people were included in the study. The average age was 52.15 ± 20.3. The most common reason of applying to the hospital was falling with 50 patients. A negative weak correlation was found between saturation and age and hospital stay. In terms of pathology and gender, there was no statistically significant difference in mortality.   Conclusion: As a result, in this study, thoracic trauma occurs mostly in men and due to falls and motor vehicle accidents, and the majority of injuries due to thoracic trauma can heal without follow- up or tube thoracostomy

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Background: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especiallyin the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing fullpersonal protective equipment. This study aims were to assess the characteristics and outcomes of adultswho suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams.Methods: All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed.The retrospective EMS database was conducted. EMS interventions performed between March 1,and April 30, 2020 were retrospectively screened.Results: In the study period EMS operated 527 times for OHCA cases. The average age of patientswith OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%).298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitatedpatients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% ofpatients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonaryresuscitation was ineffective and death was determined.Conclusions: The present study found that OHCA incidence rate in the Masovian population (centralregion of Poland) in March–April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneouscirculation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockablerhythms was associated with better prognosis. The prehospital mortality, even though it was high, didnot differ from those reported by other studies