Search Results (6,096)

Background/Objectives: Mechanical cardiopulmonary resuscitation (mCPR) devices offer consistent chest compressions during prolonged resuscitations and transport, but their impact on ventilation and patient outcomes remains unclear. This study aimed to compare gas exchange, metabolic parameters, and clinical outcomes in patients with ongoing manual versus mechanical CPR upon arrival at the emergency department (ED) after out-of-hospital cardiac arrest (OHCA). Methods: We conducted a retrospective analysis of 394 consecutive adult patients with non-traumatic OHCA admitted to a metropolitan cardiac arrest center between January 2019 and December 2024. Patients were categorized into three groups: Return of spontaneous circulation (ROSC) on arrival (n = 240), ongoing manual CPR (n = 107), and ongoing mechanical CPR (n = 47). Gas exchange and metabolic parameters were obtained from initial arterial blood gas (ABG) analysis and monitor readings. The primary outcome was survival to hospital discharge; secondary outcomes included 24 h survival and neurological status at discharge (CPC 1–2). Results: Survival to hospital discharge was significantly higher in the manual CPR group (8.4%) compared to 0% in the mechanical CPR group (p = 0.04). Both groups showed severe acidosis and hypercapnia upon ED arrival; however, PaCO₂ levels were significantly higher in the mCPR group (83.0 ± 25.5 mmHg vs. 72.3 ± 21.6 mmHg, p = 0.01). ROC analysis identified lactate (AUC = 0.765) and pH (AUC = 0.743) as the strongest predictors of survival, while EtCO₂ had limited prognostic value (AUC = 0.541). Conclusions: In patients with refractory out-of-hospital cardiac arrest admitted with ongoing cardiopulmonary resuscitation, mechanical CPR was associated with higher PaCO₂ levels on emergency department arrival compared with manual CPR, while other gas exchange parameters did not differ significantly. Given the limited sample size and small number of survivors, these findings are exploratory and hypothesis-generating, underscoring the need for prospective studies on ventilation during continuous chest compressions. Full article

Background/Objectives: Severe traumatic brain injury (TBI) carries high mortality, and outcomes are particularly poor when prehospital cardiopulmonary resuscitation (CPR) is required. Because these patients are often excluded from research, epidemiological data and prognostic insights are limited. This study aimed to describe characteristics and outcomes of patients with suspected severe TBI who received prehospital CPR. Methods: We performed a sub-analysis of the prospectively collected multicenter BRAIN-PROTECT registry, including all patients with suspected severe TBI who underwent prehospital CPR and were transported to a participating trauma center. Results: A total of 256 patients with suspected severe TBI who received prehospital CPR were included. Early mortality was high, with 22.6% declared dead in the emergency department and an additional 28.9% within 24 h, resulting in 48.5% 24 h survival. Thirty-day mortality was 79.9%. Among survivors, 45.7% achieved moderate disability or good recovery at discharge. Outcomes, 30-day mortality, and neurological status at discharge did not differ between isolated and non-isolated TBI. Characteristics often seen in survivors included shockable initial rhythm, reactive pupils, and lack of anisocoria. All patients without prehospital return of spontaneous circulation died. Conclusions: Although overall 30-day mortality was high, survival among patients for whom resuscitation was attempted and who reached hospital care was not negligible, and a substantial proportion of the survivors achieved moderate to good neurological recovery. Prehospital ROSC and shockable rhythms were associated with better outcomes, suggesting that resuscitation may be valuable and warranted in selected patients with potentially reversible conditions. Further studies are needed to better define prognostic factors and guide management in this highly vulnerable population. Full article

Background and Objectives: Traumatic injuries are a major public health issue, being the leading cause of death in the U.S. Advancements in medical care, injury prevention, and regional trauma systems have improved survival rates, but there is limited information on outcomes for survivors. Blunt, sharp, and firearm injuries are the primary mechanisms in trauma forensics. This study examines patient outcomes for blunt, sharp, and firearm injuries over 20 years. Materials and Methods: De-identified data were collected from the TriNetX Research network in June 2024. Patients aged 18–90 were categorized by injury type (blunt, sharp, firearm) from 2004 to 2023. Trends were analyzed by stratifying the data into 20 consecutive one-year intervals. Mortality, blood transfusions, traumatic shock, hypovolemic shock, and acute post-hemorrhagic anemia were recorded annually. Statistical analysis was performed using One Way Repeated ANOVA and post hoc Tukey testing, with significance defined as p < 0.05. Results: The study included 1,205,350 blunt, 710,875 sharp, and 144,562 firearm injuries. Firearm injuries predominantly affected males (83%) and African Americans (51%), while blunt and sharp injuries showed more demographic variability. Looking at the 20-year trends, the average age of firearm and sharp injury patients decreased by 21% (48 ± 13 to 38 ± 15, p ≤ 0.0001) and 14% (49 ± 16 to 42 ± 18, p ≤ 0.0001), respectively, while blunt injury patient age did not change significantly. Mortality rates significantly decreased from 12% for firearm, 7% for sharp, and 6% for blunt injuries in 2004 to less than 1% in 2023 for all three injury mechanisms. Blood transfusions increased 450% (2% to 11%) for firearm injuries and increased 100% for sharp and blunt injuries (1% to 2%). Traumatic shock and hypovolemic shock incidences also increased by 100% for firearm injuries (3% to 6% and 1% to 2%, respectively), while sharp and blunt injuries did not change significantly. Acute post-hemorrhagic anemia increased from 3% to 19% for firearm injuries (533% relative increase), while sharp and blunt injuries remained around 3% for the past 20 years. Conclusions: The study reveals that with improved survival rates over the last 20 years, there has been a significant increase in shock-related morbidities and blood transfusion rates, particularly for firearm injuries. These findings can inform trauma care to enhance resuscitation efforts, optimize resource allocation, and improve mortality and outcomes for these injury mechanisms. Full article

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. Full article

Point-of-care ultrasound (POCUS) is an essential component of emergency medicine, enabling rapid bedside assessment across a wide spectrum of acute conditions. Its effectiveness, however, remains constrained by operator dependency, variable image quality, and time-critical decision-making. Recent advances in artificial intelligence (AI) offer opportunities to augment POCUS by supporting image acquisition, interpretation, and quantitative analysis. This narrative review synthesizes current evidence on AI-enhanced POCUS applications in emergency care, encompassing trauma, non-traumatic emergencies, integrated workflows, resource-limited settings, and education and training. Across trauma settings, AI-assisted POCUS has demonstrated promising performance for automated detection of pneumothorax, hemothorax, and free intraperitoneal fluid, supporting standardized eFAST examinations and rapid triage. In non-traumatic emergencies, AI-enabled cardiovascular, pulmonary, and abdominal applications provide automated measurements and pattern recognition that can approach expert-level performance when image quality is adequate. Integrated AI–POCUS systems and educational tools further highlight the potential to expand ultrasound access, support non-expert users, and standardize training. Nevertheless, important limitations persist, including limited generalizability, dataset bias, device heterogeneity, and uncertain impact on clinical decision-making and patient outcomes. In conclusion, AI-enhanced POCUS is transitioning from proof-of-concept toward early clinical integration in emergency medicine. While current evidence supports its role as a decision-support tool that may enhance consistency and efficiency, widespread adoption will require prospective multicentre validation, development of representative POCUS-specific datasets, vendor-agnostic solutions, and alignment with clinical, ethical, and regulatory frameworks. Full article

Fish passage through turbines is one of the main environmental impacts of hydropower. Turbine type is a key factor influencing fish survival, and widespread Kaplan turbines are generally considered less dangerous than other turbine types. Nevertheless, while large Kaplan turbines have been extensively studied, there is limited empirical evidence about the biological impact of small, high-speed Kaplan turbines on fish survival. In this study, we conducted controlled in situ fish experiments at a small and low-head hydropower plant (1 MW; head 8 m) using balloon tags and pressure sensors to quantify real mortality in two horizontal Kaplan turbines operating at full capacity: one small turbine (1.2 m Ø, 500 rpm, and 5 m³/s) and one larger unit (1.55 m Ø, 300 rpm, and 8 m³/s). Fish (95–190 mm) were released into the intake flow and monitored post-passage. Results showed higher mortality in the small turbine, with ~80% in 24 h, many exhibiting severe mechanical injuries such as complete sectioning of the head or spinal cord, with significantly higher mortality in larger fish. In contrast, the larger turbine showed a ~60% mortality rate and fewer traumatic injuries. Our findings highlight the underestimated impact of small, high-rpm Kaplan turbines on fish survival and underscore the need for adaptive turbine operation or structural modifications to minimize ecological damage during critical migration periods. Full article

Background. Determining the cause and manner of death in scenes involving multiple and putrified bodies found in the same environment is a real challenge for forensic pathologists. While common scenarios include fires, vehicle crashes, and natural disasters, one of the most common causes is drug intoxication or poisoning, and the scene must be carefully evaluated based on circumstantial evidence. Carbon monoxide (CO) (also called “the silent killer”) remains one of the leading agents capable of producing simultaneous fatalities. In multi-body scenes, distinguishing between homicide–suicide, double suicide, and accidental deaths adds further complexity. The aim of this study is to highlight the limitations of toxicological and pathological investigations in advanced putrefaction and to emphasize the role of scene investigation in the interpretation of suspected CO-related deaths. Methods. The authors report a case of suspected CO intoxication involving two bodies in an advanced stage of decomposition recovered from the same room. The scene investigation, coupled with the presence of a malfunctioning combustion source, raised suspicion of CO exposure; however, analytical interpretation was severely constrained by the altered condition of biological samples. Results. Advanced decomposition magnifies these challenges. Putrefactive changes can mimic traumatic injuries, hide hypostasis, and compromise both macroscopic and microscopic evaluations due to autolysis and gas formation. Toxicological investigations are frequently hindered by the degradation or absence of key biological matrices such as blood, cavity fluids, or vitreous humor, rendering carboxyhaemoglobin quantification unreliable or impossible. These limitations may lead to incorrect medico-legal conclusions. Conclusions. Determining the cause and manner of death in complex multi-body scenes requires careful evaluation of circumstantial evidence and scene investigation, particularly when advanced decomposition compromises biological analyses and toxicological interpretation. Full article

Background: Congenital Insensitivity to Pain and Anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by congenital analgesia, anhidrosis, and multisystem involvement affecting the musculoskeletal, cutaneous, oral, and para-oral structures. This case report describes the oral phenotype and multidisciplinary clinical management of a child with CIPA. Case Description: A 9-year-old boy presented with poor oral hygiene, multiple severely damaged teeth, masticatory difficulty, limited mouth opening, impaired bolus control, and para-oral traumatic injuries. Medical and orthopedic history indicated recurrent painless fractures, self-inflicted injuries, cutaneous scarring, and recurrent hyperpyrexia. Oral self-injury associated with CIPA was suspected and supported by the Nociception Assessment Test and Minor’s Iodine–Starch Test. Although the clinical findings were suggestive of CIPA, the diagnosis remained presumptive due to the absence of confirmatory molecular or histopathological testing. Management: A wearable wireless continuous temperature-monitoring device was prescribed to assist in tracking hyperpyrexia associated with CIPA (RHA-CIPA). A conservative, staged, multidisciplinary treatment was planned rather than full-mouth extraction, emphasizing prevention of dental sepsis and mitigation of future self-injury. Dental procedures were performed under local anesthesia to manage discomfort related to tactile hyperesthesia. To reduce nocturnal biting and oral trauma, a hard acrylic occlusal protector was fabricated using an intraoral scanner and a 3D-printed cast. The patient was followed for 12 months. Outcomes: At the 12-month follow-up, clinical improvement was observed, with particularly notable gains in cheek elasticity and soft tissue resilience. Conclusions: This case highlights the considerable challenges involved in the interdisciplinary management of children with CIPA, including oral self-injury prevention, limited mouth opening, and the necessity of close coordination with medical specialties. These findings are descriptive observations of a single case and do not establish efficacy or generalizability of any intervention. Full article

Introduction: Traumatic brain injury (TBI) is a complex condition that may lead to alterations in cerebral hemodynamics. Impairment of cerebral autoregulatory mechanisms, as well as autonomic dysfunction, has been associated with worse patient outcomes after TBI. Aims: The purpose of this narrative review is to synthesize current evidence on impaired cerebral autoregulation, autonomic dysfunction, and their relationship with intracranial pressure in TBI. Findings: Initial studies examining waveform data have found that impaired cerebral autoregulation and autonomic dysfunction are present in a high proportion of patients after TBI. These are distinct but closely related phenomena, with current evidence suggesting a bidirectional relationship. Conclusions: Impaired cerebral autoregulation and autonomic dysfunction are closely associated. The intersection of these mechanisms is a potential target for intervention to improve patient outcomes after TBI. Additional research is needed to further characterize this relationship. Full article

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly post-traumatic stress disorder (PTSD), were not designed to capture the layered and ongoing nature of this occupational trauma. This commentary introduces the concept of Persistent Traumatic Stress Exposure (PTSE), a framework that reframes trauma among frontline workers as an exposure arising from organisational and systemic conditions rather than solely an individual disorder. It aims to reorient understanding, responsibility, and intervention from a purely clinical lens toward systems, cultures, and organisational duties of care. PTSE is presented as an integrative paradigm informed by contemporary theory and evidence on trauma, moral injury, organisational stress, and trauma-informed systems. The framework synthesises findings from health, emergency, and social care settings, illustrating how repeated exposure, ethical conflict, and institutional pressures contribute to cumulative psychological harm. PTSE highlights that psychological injury may build across shifts, careers, and lifetimes, requiring preventive, real-time, and sustained responses. The framework emphasises that effective support is dependent on both organisational readiness, the structural conditions that enable trauma-informed work, and organisational preparedness, the practical capability to enact safe, predictable, and stigma-free responses to trauma exposure. PTSE challenges prevailing stigma by framing trauma as a predictable occupational hazard rather than a personal weakness. It aligns with modern occupational health perspectives by advocating for systems that strengthen psychological safety, leadership capability and access to support. By adopting PTSE, organisations can shift from reactive treatment models toward proactive cultural and structural protection, honouring the lived realities of frontline workers and promoting long-term wellbeing and resilience. Full article

Mass spectrometry imaging (MSI) is an innovative analytical technique that integrates chemical analysis with spatial localization, enabling label-free, in situ detection and visualization of diverse biomolecules within tissue sections. This review summarizes the recent advances in the application of MSI to neurological disorders, with a focus on Parkinson’s disease, Alzheimer’s disease, schizophrenia, and traumatic brain injury. Studies have demonstrated that MSI can delineate the spatial heterogeneity of disease-related molecules—such as neurotransmitters, lipids, and metabolites—thereby providing new perspectives for understanding the pathological mechanisms of neurodegenerative and psychiatric diseases. Platforms including MALDI-MSI and DESI-MSI have been effectively employed for visualizing drug distribution, characterizing lipid metabolic pathways, and identifying spatial biomarkers. Although challenges remain in quantitative accuracy, spatial resolution, and the detection of low-abundance molecules, advances in high-resolution mass spectrometry, single-cell-level imaging, and multi-omics integration are expected to further enhance the utility of MSI in the investigation of brain diseases. Full article

Background and Clinical Significance: Macular holes are rare in pediatric patients and most often result from blunt trauma, commonly from soccer-related injuries. These cases present unique challenges due to delayed presentation, tightly adherent hyaloid layers, and difficulties with postoperative positioning. Larger, chronic macular holes have low spontaneous closure rates and poorer surgical outcomes, necessitating advanced surgical approaches. Herein we report a case of chronic traumatic macular hole in a pediatric patient that closed with an internal limiting membrane (ILM) flap surgical technique with silicone oil tamponade. Case Presentation: A 15-year-old male patient presented with a history of blunt ocular trauma from a soccer ball one year prior, resulting in a large chronic macular hole. The decision was made to perform pars plana vitrectomy with an inverted ILM flap technique and silicone oil tamponade. To stabilize the ILM flap and prevent displacement, a novel technique involving the placement of a single drop of silicone oil on the retinal surface prior to complete silicone oil fill was employed. This “silicone oil drop” technique allowed for smoother propagation of the oil over the flap, effectively securing it without the need for additional manipulation or perfluorocarbon liquid. Postoperatively, the macular hole was closed, and the patient’s vision improved. Conclusions: This case highlights the potential benefits of the ILM flap technique in treating pediatric macular holes with utilization of silicone oil as not only a tamponade but as a method to stabilize the flap. Full article

Medical history of psychopathology is, to some extent, the history of the overlapping traditions of Cartesian-Platonic dualism and physical reductionism looking for a taxonomic middle ground by means of diagnostic constructs. Building on such liminality, Freud first showed that traumatic memories could well be made of pure fantasy, a mind-only construct of experience, and still act traumatically on the patient’s body. Under that sway, Freud and Janet came to intentionally modify their patients’ memories to cure “hysterical” dysfunctional behaviours by means of hypnosis. The metaphorical practice of “writing new words in the human soul” has been adopted as a clinical device since the early days of psychotherapy, as the meaning of past experiences was clinically approached, verbally and emotionally negotiated, to remove somatic symptoms. Working on memory at the interdisciplinary level, we here show that what is nowadays referred to as the abstract mind, or psyche in medicine, is the historical precipitate of quite a unique cultural construction, resulting from the porous liminality between religious domain, philosophical theory and scientific method. We hereby address psychopathology, the philosophy of medicine and the frontiers between memory and fantasy—besides those between body and mind—to suggest how psychoanalysis can be considered more as a hermeneutic than as a science, or otherwise, how hermeneutics can be appreciated as a scientific, medical and therapeutic tool. Memory itself is addressed on the threshold between consciousness, organic life and intergenerational potential. Full article

Major traumas result from the application of multiple force components that, in adulthood, can lead to high mortality and morbidity. In forensic practice, pathological consequences arising from the rapid flexion–extension of an adult victim’s soma are observed, with typical intracranial and ophthalmological findings. The totality of these findings allows for a contribution to the definition of the Shaken Adult Syndrome (SAS). A comprehensive review, employing the PRISMA methodology, was conducted on international works pertaining to SAS. This resulted in the identification of six scientific papers, which were analyzed separately. It emerged that, for the diagnosis of SAS, the same diagnostic triad as Shaken Baby Syndrome is valid, comprising subdural hemorrhages, retinal hemorrhages, and encephalopathy. This syndrome appears to encompass a broad spectrum of pathological conditions, ranging from whiplash to diffuse axonal injury (DAI). At the conclusion of this work, we proposed a diagnostic flowchart that allows for suspected predictive diagnosis of SAS, both in live patients presenting to emergency medical services and in post-mortem cadavers. For this purpose, the collection of anamnesis and circumstantial data, the detection of external injuries, and the execution of cranial CT scans will be essential. Ultimately, microscopic examinations of the brain with specific immunomarkers and of ocular structures will enable the identification of pathognomonic findings for SAS. Full article

Post-traumatic olfactory dysfunction (PTOD) is a common and often persistent sequela of mild traumatic brain injury (mTBI), with limited evidence-based treatment options. We propose that high-frequency rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) may support olfactory recovery via top-down modulation of distributed olfactory, attentional, and reward networks, and we outline key mechanistic and methodological considerations for future studies. We summarize the case of a 70-year-old woman with severe post-traumatic hyposmia persisting for ~5 months, who underwent a 12-week, 10 Hz rTMS course over left DLPFC (36 sessions; 800 pulses/session). Using a structured door diary and repeated ratings across odour categories, she reported stepwise improvement starting around sessions 10–12 (re-emergence of pungent odours) and progressing to broad restoration, including subtle fragrances, by treatment end; no adverse events occurred. While causality cannot be inferred from a single case, this pattern is consistent with a network-level neuromodulatory effect and motivates controlled trials combining standardized olfactory testing with neurophysiology and neuroimaging. Full article