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Shevchuk V, Bezsmertnyi Y, Branitsky O, Bondarenko D, Bezsmertnyi O. Remodeling of the Fibula Stump After Transtibial Amputation. Orthop Res Rev 2024; 16:153-162. [PMID: 38799026 PMCID: PMC11128238 DOI: 10.2147/orr.s459927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
Aim To study the peculiarities of peroneal stump remodelling after transtibial amputation in the process of prosthesis usage. Material and Methods A histological study of the ends of the stumps of the fibula in 68 patients was performed. Terms after amputation: 2-8 years. Results In the 1st group the stumps with the reparative process completion were formed. In the 2nd group there were sharp disturbances of the reparative process with the formation of the cone-shaped end. In the 3rd group there was a pronounced periosteal bone formation with changes in the shape and structure of bone tissue and incompleteness of the reparative process. Conclusion Absence of balloting of the fibula stump and dense overlapping of the medullary cavity by muscles promotes complete remodelling of the fibula remnant with preservation of its organicity. Pathological remodelling of the fibula stump occurs due to its hypermobility, repeated traumatisation of the forming regenerate, neuritis of the peroneal nerve, osteogenesis disorders and structural and functional mismatch of the bone tissue to the loading conditions in the prosthesis. Morphological signs of pathological remodelling are the lack of completion of reparative regeneration, intensive bone tissue remodelling lasting for years with pronounced resorption and appearance of immature bone structures, fractures of the cortical diaphyseal layer, residual limb deformities with formation of a functional regenerates, narrowing and closure of the medullary canal with conglomerate with soft tissue inclusions. The anatomical inferiority of bone tissue formed in the process of remodelling of the fibula remnant creates a threat of stress fracture.
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Affiliation(s)
- Viktor Shevchuk
- Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Yurii Bezsmertnyi
- Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Olexander Branitsky
- Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Dmytro Bondarenko
- Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Olexander Bezsmertnyi
- Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
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Barten DG, Tin D, De Cauwer H, Ciottone RG, Ciottone GR. A Counter-Terrorism Medicine Analysis of Drone Attacks. Prehosp Disaster Med 2022; 37:1-5. [PMID: 35094728 DOI: 10.1017/s1049023x22000139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The rapid popularization of unmanned aerial vehicles (UAVs; also referred to as drones), in both the recreational and industrial sectors, has paved the way for rapid developments in drone capabilities. Although the threat of UAVs used by terrorists has been recognized by specialists in both Counter-Terrorism and Counter-Terrorism Medicine (CTM), there are limited data on the extent and characteristics of drone use by terrorist organizations. METHODS Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all terrorist attacks using UAVs from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, number and type of UAVs used, related attacks, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. RESULTS There were 76 terrorist attacks using UAVs. The first attack occurred in 2016, and the number of attacks per year varied considerably (range: 4-36). Forty-seven of the 76 attacks (70%) were successful. Twenty-seven individually listed events (36%) were related and part of nine coordinated, multi-part incidents. A total of 50 deaths and 132 injuries were recorded, which equated to 1.09 deaths (range: 0-6) and 2.89 injuries (range: 0-20) per successful attack. The mean number of UAVs used in an attack was 1.28 (range: 1-5) and multiple UAVs were used in 22% of attacks. CONCLUSION The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future, requiring CTM specialists be more proactive.
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Affiliation(s)
- Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Derrick Tin
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
| | - Harald De Cauwer
- Department of Neurology, Dimpna Regional Hospital, Geel, Belgium and Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Gregory R Ciottone
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
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Rise of the Unmanned Aerial Vehicles: An Imminent Public Health Threat Mandating Counter-Terrorism Medicine Preparedness for Potential Mass-Casualty Attacks. Prehosp Disaster Med 2021; 36:636-638. [PMID: 34334152 DOI: 10.1017/s1049023x21000765] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The mass proliferation and increasing affordability of unmanned aerial vehicles (UAVs) in recent years has given rise to weaponized UAV use by terrorists, leading to mounting and credible concerns this attack methodology will be the next terrorism modus operandi. Counter-Terrorism Medicine (CTM) specialists need to consider how UAVs alter or create new mass-casualty scenarios that can further exploit existing medical preparedness vulnerabilities. With an opportunity to be proactive in disaster prevention, mitigation, and preparedness, it is imperative this gathering storm be acknowledged and stakeholders explore how best to prepare for, respond to, and mitigate the consequences of UAV incidents.
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Dootz F, von Stackelberg OM, Abaya J, Jacobi C, Mohs C, Craemer EM, Rangger C, Meyding-Lamadé U, Lamadé EK. Better be prepared: the spectrum of neuropsychiatric impairment among Libyan war victims transferred to Germany for trauma rehabilitation. Neurol Res Pract 2021; 3:36. [PMID: 34218812 PMCID: PMC8256548 DOI: 10.1186/s42466-021-00134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The current Libyan civil war has originated many casualties, imposing medical challenges. War injuries are complex, requiring specialized knowledge and interdisciplinary assessment for adequate patient and intercultural management. Methods This retrospective study analyzed records of 78 Libyan patients admitted from July 2016 to November 2017 to neurological and trauma surgical departments of Krankenhaus Nordwest, Frankfurt, Germany. Issues of system preparation of the hospital, demographics, injury patterns and therapies were analyzed. The chi-squared test was used to analyze differences in injury patterns in explosion and gunshot injuries. Results Seventy-seven of seventy-eight patients were male (mean age 30.6 years). The patients received primary and secondary treatment in Tunisia (n = 39), Libya (n = 36) and Turkey (n = 23). Forty-eight patients had gunshot injuries, 37 explosion injuries, 11 both. Preparation for management of injuries included hygienic and isolation protocols, organization of interpreters and intercultural training. Patients presented with a broad variety of neurological, psychiatric and trauma surgical injuries. Fifty-six patients had sensory, 47 motor deficits. Nine reported headache, 5 vertigo, 13 visual impairment, 28 psychiatric symptoms. Eighteen patients had central nervous damage, 50 peripheral nervous damage. Central nervous damage was significantly more common in gunshot than explosion injuries (p = 0.015). Peripheral nervous damage was more common in explosion than gunshot injuries (p < 0.1). Fifty-one patients had polytrauma and 49 suffered from fractures. Therapy included surgical interventions (n = 56) and physiotherapy. Structured rehabilitation programs were often indicated. Conclusion Specialized knowledge about war injuries and their management including hospital preparation and planning regarding infrastructure may be required anytime. Injuries include a broad variety of neurological, psychiatric and trauma surgical injuries. Therefore, an interdisciplinary approach is crucial.
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Affiliation(s)
- Felix Dootz
- BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen am Rhein, Germany
| | | | - Joan Abaya
- Ludwig-Maximilians-Universität, Munich, Germany
| | - Christian Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Christoph Mohs
- Department of Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany
| | - Eva Maria Craemer
- Department of Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany.,International Institute of Medicine and Telemedicine, Frankfurt/Main, Germany
| | - Christoph Rangger
- Orthopedics and Trauma Surgery, Optimum Orthopädie, Frankfurt/Main, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt/Main, Germany.,International Institute of Medicine and Telemedicine, Frankfurt/Main, Germany
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Heszlein-Lossius HE, Ismail A, Al-Borno Y, Shaqqoura S, Skaik N, Hinnawi IA, Matar M, Gilbert M. Disturbing medical findings in war-related traumatic amputation patients: a clinical descriptive study from Gaza. BMJ Open 2020; 10:e034648. [PMID: 32571856 PMCID: PMC7311037 DOI: 10.1136/bmjopen-2019-034648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore possible long-term negative health effects of injuries sustained by modern weaponry. SETTING The study was conducted in Gaza's main hospital, Al-Shifa Hospital. PARTICIPANTS During the last 10 to 15 years, thousands of civilian Palestinians in Gaza have survived numerous military incursions, but with war-related traumatic injuries caused by explosive weapons. It is unclear to which extent the injuries sustained by such modern weaponry may increase survivors' risks of negative long-term health effects and serious illness. We have reported mechanisms and severity of injury, demographics and psychosocial status among 254 Palestinian patients in Gaza with war-related extremity amputations. Among the same amputees, subgroups of patients presented a variety of alarming symptoms and findings. 94 patients received further diagnostic clinical exploration, radiology imaging and clinical chemistry laboratory tests at the main clinical centre in Gaza, the Al-Shifa Hospital. RESULTS Nine out of ten of the referred patients were young (median 31.5 years) males (88/94, 92.6%). Ultrasound imaging revealed that 19 of 90 patients (20%) had fatty liver infiltration, 3 patients had lung nodules and 10 patients had lung atelectasis on chest CT. Twelve had remaining shrapnel(s) in the chest, five patients had shrapnel(s) in the abdomen and one in the scrotum. We found shrapnel(s) in the amputation stumps of 26 patient's amputated limbs, while 8 patients had shrapnel in the non-amputated limb. Three patients had liver lesions. Nineteen patients had elevated liver enzymes, 32 patients had elevated erythrocyte sedimentation rate and 12 were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (HBV). One of the 19 patients with fatty liver tested positive for HBV. Two of the patients with fatty liver infiltration had elevated glycatedhaemoglobin levels and confirmed diabetes mellitus type II. CONCLUSION Nearly half (44, 8%) had remaining metal fragments from explosives of unknown composition harboured in various parts of their bodies. All patients identified with lesions and nodules are being followed up locally. As of now, we cannot anticipate the long-term health consequences of living with metal residuals from modern explosive weapons embedded in body organs and tissue.
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Affiliation(s)
- Hanne Edoy Heszlein-Lossius
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Anas Ismail
- Faculty of Medicine, Al-Azhar University, Gaza, Palestine
- Al-Shifa Medical Centre, Gaza, Palestine
| | | | | | | | | | | | - Mads Gilbert
- The Anaesthesia and Critical Care Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Clinic of Emergency Medicine, University Hospital of North Norway, Tromsø, Norway
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AlWaheidi S. Breast cancer in Gaza-a public health priority in search of reliable data. Ecancermedicalscience 2019; 13:964. [PMID: 31921335 PMCID: PMC6834385 DOI: 10.3332/ecancer.2019.964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/18/2023] Open
Abstract
Gaza has experienced 12 years of isolation which has crippled the health system infrastructure, reduced the quality of living conditions, damaged the health of the population and reduced health service capacity and capability. This paper presents a context-setting review of what is already known about breast cancer in Gaza to identify which interventions are applicable to help prevent women there from dying unnecessarily from breast cancer. A search of the published and unpublished literature was conducted to identify potentially relevant studies on breast cancer which were either done in Gaza or elsewhere in the occupied Palestinian territory. This paper highlights the pervasive lack of basic modalities of cancer care (surgery, radiotherapy, systemic therapies and pathology/imaging) in Gaza. Poor access to breast cancer services in Gaza leaves women with only one alternative—to seek treatment outside of Gaza. However, women are sometimes forced to wait months before receiving permits to leave Gaza for treatment. Furthermore, a lack of complete and reliable data remains a major challenge for improving breast cancer services in Gaza. There is a need to develop and evaluate interventions to promote infrastructure for pathology and drug delivery, medical training and cancer registration and monitoring.
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Affiliation(s)
- Shaymaa AlWaheidi
- Cancer Epidemiology, Population and Global Health, School of Cancer and Pharmaceutical Sciences, King's College London, London WC2R 2LS, UK
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Mills D, Gilbert M, Wispelwey B. Gaza's Great March of Return: humanitarian emergency and the silence of international health professionals. BMJ Glob Health 2019; 4:e001673. [PMID: 31297247 PMCID: PMC6590976 DOI: 10.1136/bmjgh-2019-001673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- David Mills
- Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mads Gilbert
- Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway.,Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bram Wispelwey
- Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Heszlein-Lossius HE, Al-Borno Y, Shaqqoura S, Skaik N, Giil LM, Gilbert M. Does pain, psychological distress and deteriorated family economy follow traumatic amputation among war casualties? A retrospective, cross-sectional study from Gaza. BMJ Open 2019; 9:e029892. [PMID: 31217319 PMCID: PMC6589021 DOI: 10.1136/bmjopen-2019-029892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore determinants of psychosocial distress and pain in patients who have survived severe extremity amputation in Gaza. SETTING This study was conducted in a secondary care rehabilitation centre in Gaza, Palestine. The clinic is Gaza's sole provider of artificial limbs. PARTICIPANTS We included 254 civilian Palestinians who had survived but lost one or more limb(s) during military incursions from 2006 to 2016. We included patients with surgically treated amputation injuries who attended physical rehabilitation at a specialist prosthesis centre in Gaza. Amputees with injuries prior to 2006 or non-military related injuries were excluded.We assessed their pain and psychological stress using the General Health Questionnaire (GHQ-12). We used income, amputation severity scored by proximity to torso, current employment status, loss of family members and loss of home as independent variables. RESULTS The amputees median age was 23 years at the time of trauma, while a median of 4.3 years had passed from trauma to study inclusion. Nine of 10 were male, while 43 were children when they were amputated (17%≤18 years). One hundred and ninety-one (75%) were unemployed and 112 (44%) reported unemployment caused by being amputated. Pain was the most frequent problem, and 80 amputees (32%) reported to suffer from daily pain. Family income was significantly correlated with the physical pain (OR=0.54, CI 0.36 to 0.80, p=0.002). Psychological distress was higher among unemployed amputees (OR=1.36, CI 1.07 to 1.72, p=0.011). We found no association between psychological distress (GHQ-scores) and the extent of the initial amputation. CONCLUSION Pain and psychological distress following war-related extremity amputation of one or more limbs correlated stronger with deteriorated family economy and being unemployed than with the anatomical and medical severity of extremity amputations.
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Affiliation(s)
| | - Yahya Al-Borno
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Samar Shaqqoura
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Nashwa Skaik
- Surgical department, Al-Shifa Hospital, Gaza City, Palestine
| | - Lasse Melvaer Giil
- Department of Internal medicine, Haraldsplass Diakonale Sykehus AS, Bergen, Norway
| | - Mads Gilbert
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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