Search Results (924)

Background/Objectives: Traumatic spine injury is a major cause of morbidity and mortality in low- and middle-income countries, yet detailed epidemiologic data from sub-Saharan Africa remain limited. We used a fracture registry to characterize injury patterns, care pathways, and short-term outcomes among patients presenting with traumatic spine injury at a tertiary referral center in Ethiopia. Methods: We performed a retrospective analysis of a prospectively maintained fracture registry at a tertiary referral hospital in Ethiopia from June 2023 to July 2025. Patients with traumatic spine injury were included. Variables included demographics, injury mechanism and context, injury region, AO morphology, neurologic status (ASIA), referral status, mode of transportation, time to presentation, treatment, and 30-day outcomes. Descriptive statistics were used to summarize the cohort. Bivariate associations were assessed using chi-square or Fisher’s exact tests, and crude odds ratios were calculated for prespecified 2 × 2 comparisons. Results: A total of 252 patients were included (mean age: 33.1 ± 13.6 years; 81.3% male). Falls (45.2%) and road traffic accidents (26.2%) were the most common mechanisms, and injuries most often occurred on farms (40.1%) and roads/streets (33.7%). The thoracolumbar (31.3%) and cervical (30.6%) regions were most frequently affected. Complete spinal cord injury (ASIA A) occurred in 36.5% of patients. Most patients were referred (88.5%), 62.7% presented >24 h after injury, and 65.5% were managed non-operatively. Referral status was strongly associated with delayed presentation (OR: 10.49, 95% CI: 3.84–28.64). Thirty-day mortality was 22.2%. Complete SCI (OR: 6.17, 95% CI: 3.23–11.90) and cervical/thoracic injuries (OR: 6.54, 95% CI: 3.12–13.70) were associated with higher mortality. Conclusions: Traumatic spine injury in this Ethiopian cohort disproportionately affected young adults and was marked by severe neurologic injury, delayed presentation, and high early mortality. Full article

Background/Objectives: Falls are a significant public health issue and the second most common cause of injury and death worldwide. The risk is exceptionally high for older adults, and fall-related injuries can significantly affect their well-being and lead to pain, disability, and loss of independence, necessitating urgent redressal of this issue. This study assesses the fall risk among older patients at a referral hospital in Riyadh, Saudi Arabia. Methods: This cross-sectional study included 246 older adults aged 65 years and older from the Internal Medicine Department. Data were gathered through a survey addressing sociodemographic characteristics, fall risk assessment, prevention knowledge, behaviors, and social support. Results: A high fall risk and good knowledge of fall prevention were observed in older adults. A weak-to-moderate positive correlation was found between behavior and fall risk. Correlations were observed among age, fall prevention behavior, educational level, and fall prevention knowledge. Conclusions: While a weak-to-moderate positive association was found between fall risk and positive behaviors, no statistically significant association was observed between fall risk and fall prevention knowledge or social support. This indicates that factors other than knowledge and social support may play a critical role in influencing fall risk. Behavioral interventions alone may not reduce fall incidence sufficiently unless other underlying factors are addressed. Full article

This paper develops a shock-absorbing asphalt mixture for pedestrian pavements that mitigates the impact of normal walking on pedestrians’ bodies by incorporating crumb rubber from recycled tires to produce a soft mixture. This aims to reduce injuries to vulnerable road users, enable the rethinking of urban pavement designs, and address the major challenges facing societies, ultimately achieving more sustainable, resilient, and safer cities. To promote land sustainability, the designed asphalt mixture should be pervious, allowing water to infiltrate into the underlying soil. The development of the asphalt mixture followed an experimental methodology that involved formulating asphalt mixtures with conventional bitumen, polymer-modified bitumen, and bituminous emulsion. The shock-absorbing capability was evaluated by measuring the deformation of the asphalt mixture over time in response to a falling weight from a Light Falling Weight Deflectometer. Permeability capabilities were assessed through the permeability test. Subsequently, the asphalt mixture was characterized according to its macrotexture, friction, air void content, rutting resistance, and stiffness to assess its suitability as a walking surface material. Results indicate that increasing rubber content enhances deformation capacity and improves cushioning but reduces stiffness. Among the solutions, mixtures with polymer-modified bitumen and intermediate rubber content achieved the balance between impact attenuation and mechanical performance. Full article

Background and Objectives: Simultaneous bilateral scapular fractures are exceptionally rare injuries and are most commonly associated with high-energy trauma, convulsions, or electrical injury. Their occurrence following low-energy trauma is extremely uncommon. This study aimed to conduct a scoping review of the literature on simultaneous bilateral scapular fractures, with emphasis on demographic characteristics, mechanisms of injury, fracture patterns, treatment strategies, and clinical outcomes. To provide clinical context, the findings are illustrated by a case of a 43-year-old previously healthy recreational athlete who sustained simultaneous bilateral scapular fractures after a low-energy fall directly onto the back. Materials and Methods: A scoping review of the literature was conducted in accordance with PRISMA-ScR guidelines using the PubMed/MEDLINE and Scopus databases. Studies reporting simultaneous bilateral scapular fractures were identified and analyzed with respect to demographic characteristics, mechanisms of injury, fracture patterns, treatment modalities, and outcomes. Results: Thirty-seven studies published between 1946 and 2025 were included, comprising a total of 43 patients. Most cases resulted from high-energy trauma (41.9%), convulsions (25.6%), or electrical injury (16.3%). Low-energy trauma and spontaneous fractures were rare. The scapular body was the most commonly involved anatomical region. Conservative treatment predominated and was generally associated with favorable functional outcomes, while surgical intervention was reserved for displaced or intra-articular fractures. The illustrative case involved bilateral comminuted extra-articular fractures of the scapular bodies and spines without associated injuries and was managed conservatively, resulting in complete fracture healing and full, painless shoulder range of motion. Conclusions: The findings of this scoping review, illustrated by the representative clinical case, indicate that simultaneous bilateral scapular fractures may occur even after low-energy trauma in otherwise healthy individuals. Bilaterality alone should not be interpreted as an independent indication for surgical treatment when fractures are stable and minimally displaced. A high index of clinical suspicion and appropriate radiological evaluation are therefore warranted, particularly in emergency and trauma settings, in order to avoid missed or delayed diagnosis, even in cases with seemingly benign mechanisms of injury. Full article

Falls are a leading cause of paediatric injuries, yet school-based prevention relies heavily on subjective observation rather than objective biomechanical assessment. This paper introduces the Safe Fall framework, integrating a judo-inspired educational programme with an occlusion-robust computer vision pipeline to quantify safe falling strategies. We analysed video recordings of 285 schoolchildren using a multi-stage architecture combining YOLOv8 for detection, SAM 2 for segmentation, and MMPose for skeletal tracking. The intervention yielded significant improvements in 60% of kinematic metrics ($p<0.05$), most notably a $+61.4\%$ increase in descent rate and expanded rolling ranges, indicating a shift from hazardous “freezing” behaviours to controlled energy dissipation. Unsupervised clustering confirmed a migration of students towards safe motor profiles, while a Random Forest classifier achieved an accuracy of 98.3% and an AUC of 0.998 in distinguishing fall quality. These findings demonstrate that integrating pedagogical training with automated vision modelling provides a scalable and evidence-based approach for reducing injury risk in real-world school environments. Full article

Same-level falls are the most frequent occupational accidents, yet traditional manual analysis of accident reports is labor-intensive and limits large-scale prevention strategies. In this pilot study, we aimed to evaluate the accuracy of using large language models (LLMs) to automate the classification of occupational accident text data without task-specific pretraining. We analyzed data from 2619 same-level-fall-related injury cases, using expert manual classification as the reference standard. Four models—GPT-4o mini, GPT-4.1 mini, GPT-4.1, and o4-mini—were compared using accuracy and Cohen’s kappa. The o4-mini model demonstrated the highest performance, showing statistical superiority in the complex “causal agent” category with 72.8% accuracy. For other classification tasks, the top models achieved accuracies of 82–92%, with Cohen’s kappa coefficients > 0.7, indicating substantial agreement with expert judgments. These findings suggest that LLMs can classify occupational accident text with substantial agreement with the expert-derived reference standard in this dataset. This automated approach enables efficient, high-frequency analysis of large datasets, offering a promising tool for large-scale occupational accident surveillance and screening. Full article

Background: Upper limb functional performance depends on the interaction of strength, mobility, and neuromuscular control, while inter-limb asymmetries may increase injury risk. However, comprehensive analyses integrating these factors remain limited. This study aimed to evaluate sex differences and identify functional phenotypes in young adults using a multidimensional assessment approach. Methods: Forty-six healthy young adults (23 women, 23 men) underwent a comprehensive battery of upper limb assessments, including anthropometric measurements, maximal handgrip strength, isometric elbow flexion and extension torque, postural stability via the Fall Risk Index (FRI), and functional reach using the Upper Quarter Y-Balance Test (YBT-UQ). Inter-limb symmetry was calculated using the Limb Symmetry Index (LSI). K-means clustering was applied to standardized variables to identify latent functional phenotypes. Results: Men demonstrated significantly greater body mass, height, limb length, and absolute strength (p < 0.01), while functional performance (YBT-UQ composite scores) and inter-limb symmetry were similar between sexes. Strength asymmetry was most prevalent for elbow flexion and handgrip strength (up to 89%), whereas stability asymmetry was less frequent (≈54%). Three functional clusters were identified: Cluster 1—high strength and moderate stability, Cluster 2—lower anthropometry and strength, Cluster 3—high strength but reduced stability and increased asymmetry. Despite phenotypic differences, composite functional performance was comparable across clusters. Conclusions: Upper limb function reflects the interaction of morphological and neuromuscular factors rather than strength alone. Observed asymmetries should be interpreted within a functional context, as moderate asymmetries may represent normal variation in motor control, while larger asymmetries may indicate potential functional imbalance; however, due to the cross-sectional design of this study, no causal inferences regarding injury risk can be made. Functional phenotyping provides a framework for individualized training, screening, and rehabilitation strategies. Full article

Postharvest losses in Pacific Island Countries remain a significant challenge, affecting food security and farmers’ livelihoods. Limited research exists on horticultural handling practices in the region, particularly on taro corm bruising. This study characterised defects in taro corms caused by poor physical handling using a simulated laboratory drop test with two drop heights (1 m and 2 m), two drop frequencies (1 and 4 drops), and three storage durations (3, 5, and 7 days). It examined the combined effects of the drop test on external bruising, internal bruise depth, bruise severity scores, and visible decay incidence. Data were collected using the laboratory drop test, samples of farmer-handled taro, and farmer interviews. The results showed that the increased drop height and repeated impacts significantly increased severity, depth, and length over time. Corms subjected to the higher drop height (2 m) exhibited greater tissue breakdown; by day 7, corms dropped from 2 m had approximately 47% greater bruise depth than those dropped from 1 m. Statistical analysis confirmed that the drop height, the storage duration, and the drop frequency were key determinants of postharvest deterioration (p < 0.05). Mechanical stress also weakened corm integrity, increasing susceptibility to infection and decay. These findings underscore the need for improved postharvest handling practices, such as minimising free-fall distances, using padded storage and adopting better sorting methods to reduce mechanical injury. Enhancing these practices could substantially reduce food loss, extend taro shelf life and improve marketability, thereby supporting more resilient and sustainable food systems and contributing to food security and economic stability for taro farmers in the Pacific. Full article

The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24–10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28–7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06–0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04–8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning. Full article

Background: Frailty is a key predictor of adverse surgical outcomes in older adults. However, the prognostic utility of the 5-factor modified frailty index (mFI-5) for short- and long-term outcomes following total hip arthroplasty (THA) remains inadequately defined. This study assessed the association between frailty severity, measured by the mFI-5, and postoperative complications, implant survivorship, and mortality following primary THA in a large national cohort. Methods: This retrospective cohort study included 90,660 patients aged ≥50 years undergoing primary THA for osteoarthritis from 2003 to 2020 using the TriNetX research network. Patients were stratified by frailty severity based on mFI-5 scores: non-frail (0–1), moderately frail (2), and severely frail (≥3). Cases of fractures, polytrauma, or falls were excluded. Pairwise propensity score matching was adjusted for age, sex, race, and BMI. Outcomes included 90-day medical and surgical complications, healthcare utilization, and 2- and 5-year THA revision and mortality rates. Risk ratios (RRs) with 95% confidence intervals (CIs) and Bonferroni-corrected significance thresholds (p < 0.0167) were reported. Results: Severely frail patients had significantly increased risks of 90-day mortality (RR 4.41, 95% CI 2.22–8.74), acute kidney injury (RR 2.92), myocardial infarction (RR 3.61), and periprosthetic joint infection (RR 2.02) compared to non-frail patients. At five years, severely frail patients demonstrated a 58% higher revision risk (RR 1.58) and 23.0% mortality versus 6.9% in the non-frail cohort. A dose-dependent risk gradient was observed, with moderately frail patients exhibiting intermediate risks across all outcomes. Conclusions: Frailty severity, as measured by the mFI-5, was associated with a stepwise increase in short- and long-term complications and mortality following THA. The mFI-5 may serve as a practical, scalable tool for preoperative risk stratification, counseling, and resource planning in older adults undergoing primary THA. Full article

Background and Objectives: Severe COVID-19 frequently fulfills Sepsis-3 criteria and is characterized by thrombo-inflammation and endothelial injury. We evaluated whether a bedside endothelial activation index (EAI = D-dimer/fibrinogen) identifies biologically distinct phenotypes and relates to interleukin-6 (IL-6) response after therapeutic plasma exchange (TPE), and whether baseline IL-6 predicts a ≥50% IL-6 reduction. Methods: Retrospective single-center ICU cohort of adults with SARS-CoV-2 infection, sepsis-related organ dysfunction, and ≥1 TPE session (n = 51). Patients were stratified by median EAI (low vs. high). Outcomes included peri-procedural biomarker/physiology changes (post–baseline), IL-6 responder status (≥50% reduction), correlations with IL-6 reduction (%), and multivariable predictors of response. Results: Compared with low EAI (n = 25), high EAI (n = 26) had higher baseline D-dimer (6.2 vs. 2.2 µg/mL) and lower fibrinogen (2.9 vs. 7.1 g/L) (both p < 0.001). Low EAI showed larger CRP decreases (ΔCRP −84.0 vs. −2.3 mg/L; p = 0.001) and larger fibrinogen falls (Δ −3.1 vs. −0.4 g/L; p < 0.001), while high EAI had larger D-dimer decreases (Δ −2.5 vs. −0.6 µg/mL; p = 0.004) and a modest SOFA improvement (Δ −0.3 vs. +0.1; p = 0.026). IL-6 responders (n = 20) had higher baseline IL-6 than non-responders (365.2 vs. 47.1 pg/mL; p < 0.001). Baseline IL-6 independently predicted response (per doubling: OR 1.94, 95% CI 1.27–2.95; p = 0.002), while age reduced odds (OR 0.91/year, 95% CI 0.84–0.99; p = 0.032). IL-6 reduction correlated with ΔCRP (ρ = −0.41; p = 0.003) and ΔPaO₂/FiO₂ (ρ = 0.37; p = 0.01). Conclusions: EAI stratifies distinct thrombo-inflammatory patterns around TPE, while baseline IL-6 is the dominant predictor of achieving large IL-6 reductions. To emphasize the novelty and clarify the study objective, this exploratory analysis used a phenotype-stratified framework to test whether a simple bedside endothelial activation index could enrich biological response assessment to adjunctive TPE. The prespecified primary outcome was achievement of a ≥50% IL-6 reduction after completion of the TPE course; secondary outcomes included peri-procedural biomarker, oxygenation, SOFA, and ICU endpoints. Full article

Background/Objectives: Severe acquired brain injury (sABI) disrupts early rehabilitation because arousal fluctuates, trunk control is fragile, and agitation limits therapy tolerance; land-based practice is frequently constrained by fall risk and staffing. We aim to reframe aquatic therapy as a programmable multisensory environment to stabilize arousal and support axial alignment before conventional impairment targets are feasible. Here, programmable denotes the deliberate titration and reporting of water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support as intervention inputs. Methods: This perspective integrates principles from neurobehavioral assessment, motor control, and immersion physiology to propose the Arousal–Alignment–Action loop as a falsifiable model and to define manipulable aquatic inputs (water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support) as dosing parameters. We outline a pragmatic testing ladder (within-session micro-experiments, feasibility studies, and embedded evaluations) and a minimal outcomes and confounder set to support cumulative evidence. Results: The framework links state regulation to alignment and goal-directed behavior, specifies predictions that can fail, and highlights boundary conditions (sedation, autonomic instability, pain, recent surgery or wounds, and cervical or cardiopulmonary constraints). A minimal outcome package spanning arousal/responsiveness, trunk control, behavioral dysregulation, participation/tolerance, and basic physiology is proposed, with optional objective adjuncts for mechanism-oriented studies. Conclusions: Treating water as a measurable and titratable medium, rather than a generic modality, may reduce early intensity bottlenecks and improve implementability and comparability of aquatic neurorehabilitation research in medically stable sABI; however, the model is intended as hypothesis-generating until supported by stronger direct clinical evidence. Full article

Dry eye disease (DED) is an ocular surface disorder characterized by tear film instability, inflammation, epithelial damage, and neurosensory abnormalities. Due to its multifactorial etiology and pathophysiology, conventional therapies that focus on lubrication and immunosuppression often fall short in addressing the neuropathic component of ocular pain experienced by a growing subset of patients. Recent developments in sensory neuroscience have highlighted the pivotal role of ion channels in mediating ocular surface homeostasis, pain signaling, and inflammation. This review examines the role of the following major ion channel families in the pathophysiology of DED and neuropathic ocular pain: transient receptor potential (TRP) channels, voltage-gated sodium (Nav) channels, and purinergic P2X receptors. The review details their anatomical distribution, molecular function, and responses to environmental stimuli such as heat, cold, osmolarity, and injury. Current treatments, such as artificial tears, anti-inflammatory drops, and systemic neuromodulators, are also reviewed in relation to their effects on ion channel modulation. Additionally, emerging therapies that directly target sensory transduction pathways are introduced. This review highlights the therapeutic potential of ion channel modulation in personalizing treatment for patients with ocular surface pain, particularly those with neuropathic features unresponsive to standard care. Full article

Background: Traumatic spinal injuries (TSI) are often associated with substantial physical burden and potential psychological consequences. Early detection of depressive symptoms may be important for improving quality of life during recovery. Despite the high prevalence of injury, unique sociocultural factors affecting mental health, and the need to optimize long-term rehabilitation outcomes, there is a lack of longitudinal assessments of depression in TSI patients in this region of the MENA (Middle East and North Africa). This study aimed to examine the occurrence of depressive symptoms following TSI over a 3-month period. Methods: A prospective cohort study was conducted to assess the occurrence of depression in TSI patients admitted between 2019 and 2022 at the Hamad Trauma Center. Conscious patients aged 18–65 years diagnosed with TSI were included. Perceived social support was assessed using the RAND Social Support Survey (Medical Outcomes Study Social Support Survey), a validated instrument measuring multiple dimensions of social support. Patient Health Questionnaire-9 (PHQ-9), a widely validated self-administered screening tool for depressive symptoms, was utilized twice: at 2 weeks and at 3 months post-trauma to evaluate early-onset depressive symptoms and their persistence or resolution over time. Results: A total of 189 TSI were included. The cohort was predominantly young individuals. The most common mechanisms of injury included falls (42.1%) and motor vehicle crashes (31.1%). The mean Injury Severity Score was 16.5 ± 8.2 and the spine Abbreviated Injury Scale score was 2.4 ± 0.7. Injuries involved cervical (32.8%), thoracic (38.1%), and lumbo-sacral (6.9%) regions. A total of 32.6% underwent spinal surgery, and 9.0% experienced neurological deficits. Most patients reported emotional and informational support (69%), and 62% reported caregiving support. At 2 weeks post-trauma, patients demonstrated mild depressive symptoms, with a mean PHQ-9 score of 4.6 ± 5.1, which decreased to 2.5 ± 4.2 at 3 months. The proportion of patients screening positive for depressive symptoms (PHQ-9 ≥ 5) decreased from 39.1% (52/133) at 2 weeks to 19.5% (26/133) at 3 months, corresponding to a 19.6% absolute reduction over the follow-up period. A subset of patients reported increased feelings of depression or hopelessness and sleep disturbances at three months compared with two weeks post-trauma. Conclusions: Patients with TSIs experience psychological distress in the early post-injury period, with a subset screening positive for depressive symptoms. Although depressive symptom scores declined over 3 months, continued psychological screening and follow-up care remain important components of comprehensive TSI management during recovery and rehabilitation. Our results should be considered cautiously because of gender-biased findings, single center data and potential attrition bias. Full article

Background/Objectives: Suicide attempts represent a major global health problem. Traumatic suicide methods, such as falls from great heights, stab wounds, and gunshot wounds, frequently result in severe or fatal injuries. The COVID-19 pandemic, as well as broader societal stressors including economic uncertainty and geopolitical conflicts, has substantially increased psychological stress in the population and has been discussed as a potential influencing factor for suicidal behavior. The aim of this study was to analyze severe traumatic suicide attempts and to evaluate the potential influence of the COVID-19 pandemic in a multicenter analysis of the TraumaRegister (TR) DGU^®. Methods: This retrospective multicenter analysis is based on the TraumaRegister DGU^®, a standardized database for seriously injured patients. Patients from Germany, Austria, and Switzerland from 2010 to 2023 with an Injury Severity Score (ISS) ≥ 9, an age ≥ 10 years, and a documented suicide attempt, who arrived at the hospital alive, were included. Results: Among severely injured trauma patients recorded in the registry, 12,247 (4.4%) cases were classified as suspected traumatic suicide attempts. Severe traumatic suicide attempts showed a clear age-dependent distribution, with a marked increase from adolescence and a plateau between 20 and 55 years of age. Both the mean age of the general population and the age of patients with suicide attempts increased over the study period. This trend was reflected in the rise in the ≥70-year age group from 13.6% in 2010 to 19.6% in 2023. The most common method was jumping from a height greater than 3 m (65.3%), followed by stab wounds (11.9%) and gunshot wounds (8.0%). While a significant decline in severe traumatic suicide attempts was observed between 2010 and 2019, a significant increase to 4.5% occurred in 2020, remaining at a comparable level in the following years. Sex-specific differences were observed, with penetrating injuries occurring more frequently in men, whereas jumps from heights > 3 m were more common among women. The highest hospital mortality was observed in gunshot injuries (67.9%). Conclusions: This study demonstrates an increase in severe traumatic suicide attempts in 2020 that persisted at a similar level until 2023. Sex-specific differences in suicide methods highlight the need for targeted prevention strategies. In addition, demographic aging is reflected in the increasing proportion of suicide attempts among older individuals, emphasizing the need for age-specific prevention measures. The relatively high survival rate after certain methods, particularly after falls from height (77%), underlines the importance of structured postoperative psychiatric care pathways. These findings specifically reflect traumatic suicide attempts resulting in severe injury and requiring trauma center treatment. Full article