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Corral Nunez C, Hurtado A, Latapiat Parodi A, Osorio Larraín R, Ríos Erazo M, Herrera Ronda A, Varas Reyes J, Rojas Alcayaga G. Traumatic dental injuries sustained during Chile's civil unrest: A case series study. Dent Traumatol 2024; 40:316-324. [PMID: 37997492 DOI: 10.1111/edt.12911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND/AIM During Chile's period of social unrest, numerous people suffered physical trauma due to the use of police force. However, there have been no reports regarding traumatic dental injuries (TDIs) suffered in this context. This study aims to describe the dental trauma of patients injured by police during the social unrest period in Chile from 2019 to 2021. MATERIAL AND METHODS A case series methodology was employed. Following informed consent, clinical records of patients admitted to the Ocular and Dentomaxillofacial Prosthetic Care and Rehabilitation Program, who were affected by the violence of state agents during social mobilizations, were reviewed from October 2019 to December 2021. Information on the sociodemographic characteristics of the patients and the TDI diagnoses with their treatment needs were collected. A descriptive analysis was performed. RESULTS Forty-six patients were identified, nine of whom agreed to the informed consent. Most were male, with a mean age of 28 years, public health insurance, and a high educational level. The most common causes of injury were kinetic impact projectiles (KIPs) and the use of physical force (punches, kicks, or pushes). Of the nine cases described, 26 teeth were affected by TDI. The most affected teeth were the central upper incisors and, in most cases, they presented lesions in both injury categories: NA0D.0 (the tooth and pulp) and NA0D.1 (periodontal tissues). Treatment needs varied and included some complex procedures, such as implant-retained crowns and removable dental prostheses. CONCLUSIONS The use of force by police during the period of social unrest in Chile caused TDIs among demonstrators, which were mainly due to physical force from less-than-lethal weapons. Most cases presented injuries affecting the incisors with multiple teeth requiring complex treatments.
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Affiliation(s)
- Camila Corral Nunez
- Department of Restorative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Alvaro Hurtado
- Department of Restorative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - André Latapiat Parodi
- Department of Restorative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Rodrigo Osorio Larraín
- Department of Restorative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Matías Ríos Erazo
- Behavioral Sciences Area, Institute for Dental Sciences Research, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Andrea Herrera Ronda
- Behavioral Sciences Area, Institute for Dental Sciences Research, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Joaquín Varas Reyes
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gonzalo Rojas Alcayaga
- Behavioral Sciences Area, Institute for Dental Sciences Research, Faculty of Dentistry, University of Chile, Santiago, Chile
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Das S, Saha A, Banerjee A, Goyary D, Karmakar S, Dwivedi SK, Chattopadhyay P. Toxicological evaluation of a nonlethal riot control combinational formulation upon dermal application using animal models. Cutan Ocul Toxicol 2023; 42:118-130. [PMID: 37315295 DOI: 10.1080/15569527.2023.2220393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
Numerous adverse effects on human health have been reported in epidemiological studies of oleoresin capsicum (OC) and other riot control agents (RCAs). Importantly, the daunting risk of such RCAs can be neutralized by optimizing the desired concentration of such agents for mob dispersal. Hence, a nonlethal riot control combinational formulation (NCF) was prepared for dispersing rioters without imparting fatal outcomes. However, for desired utilization of NCF, it is essential to recognize its extent of potential toxicity. Therefore, the current investigation evaluated the dermal toxicity of NCF using experimental animals in compliance with the OECD guidelines. Additionally, few essential metal ions were analyzed and found non -significantly different in the test rats as compared to control rats. Moreover, abnormal dermal morphology and lesions ultrastructural tissue defects were not noticed as evinced by different studies like ultrasonography, histology, and scanning electron microscopy (SEM) respectively. Further, Doppler ultrasonography exhibited non-significantly different blood flow velocity in both groups, whereas miles test demonstrated a significantly increased Evans blue concentration in test rats compared to the control rats, which might be due to an initial increase in blood flow via an instant action of the NCF at the cutaneous sensory nerve endings. However, our results demonstrated NCF can produce initial skin irritating and sensitizing effects in guinea pigs and rabbits without the antecedence of acute toxicity (≤2000 mg/kg) in Wistar rats.
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Affiliation(s)
- Sanghita Das
- Defence Research Laboratory, Tezpur, India
- Department of Chemical Technology, University of Calcutta, Kolkata, India
| | - Achintya Saha
- Department of Chemical Technology, University of Calcutta, Kolkata, India
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Nogee D, Therriault C, Yeh M, Kieszak S, Schnall A, Brown K, Bronstein A, Chang A, Svendsen E. Monitoring trends in lacrimator exposures using the National Poison Data System: 2000-2021. Clin Toxicol (Phila) 2023; 61:543-550. [PMID: 37417363 PMCID: PMC11348396 DOI: 10.1080/15563650.2023.2227999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Lacrimators are used by individuals for personal defense and by police for crowd control during periods of civil unrest. Increased public awareness about their use has raised concerns about their application and safety. OBJECTIVE To characterize patterns of lacrimator exposures in the United States, we describe temporal trends of calls to poison centers by demographics, substances, medical outcomes, exposure sites, and scenarios. METHODS A retrospective data analysis was performed for all single-substance lacrimator exposures in the United States reported to the National Poison Data System between 2000 and 2021. Descriptive analyses were performed to examine demographic characteristics, geographic distribution, product types and medical outcomes associated with lacrimator exposures. RESULTS A total of 107,149 lacrimator exposure calls were identified. There was an overall decrease in calls per year, from 6,521 calls in 2000 to 2,520 in 2020, followed by an increase to 3,311 calls in 2021. A declining trend was observed independent of total poison center call volume. Oleoresin capsicum was the most commonly reported substance (81,990, 76.5%). Individuals ages 19 years and younger accounted for 62% of calls, but adults ages 20 and over were more likely to develop major clinical effects (odds ratio 3.03; 95% confidence interval 1.91-4.81; P < 0.0001). The most common exposure site was "own residence," followed by schools. School exposures accounted for 15.8% of exposures in children ages 6-12 years and 37.7% in adolescents. Among calls with documented scenarios, 19.7% involved unintentional exposures due to children accessing lacrimators. CONCLUSION Lacrimator exposure calls to United States poison centers decreased from 2000 to 2021. Most calls pertain to oleoresin capsicum and individuals ages 19 and younger. Improper storage allowing children to have access to these chemicals, is a common scenario. Public safety interventions such as education about safe storage and use of lacrimators, improved product design, or regulatory changes may prevent unintentional exposures.
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Affiliation(s)
- Daniel Nogee
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
| | - Colin Therriault
- Department of Emergency Medicine, University of IL Chicago College of Medicine, Peoria, IL, USA
| | - Michael Yeh
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
| | - Stephanie Kieszak
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
| | - Amy Schnall
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
| | | | - Alvin Bronstein
- HI State Department of Health, Emergency Medical Services Injury Prevention System Branch, Honolulu, HI, USA
| | - Arthur Chang
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
| | - Erik Svendsen
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA, USA
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Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. FRONTIERS IN TOXICOLOGY 2023; 5:1118731. [PMID: 36733462 PMCID: PMC9887149 DOI: 10.3389/ftox.2023.1118731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Riot Control Agents (RCAs) are chemical compounds used by law enforcement agencies to quell violent demonstrations as an alternative to lethal force and as part of police/military training. They are also known as tear gases because of the hallmark ocular irritation and lacrimation they cause. The most common RCAs include oleoresin capsicum (contained in Mace and pepper spray), chlorobenzylidene malononitrile, dibenzoxazepine, and chloroacetophenone (previously the main content of Mace); some of which have been in use for decades. Their immediate incapacitating effects are mediated through polymodal afferent fibers innervating the corneal surface, inducing the release of peptides that cause neurogenic inflammation. Although previously thought to have only transient effects on exposed patients more severe complications such as corneal stromal opacities, corneal neovascularization, neurotrophic keratopathy, conjunctival necrosis, and pseudopterygium can occur. Concerningly, the lack of research and specific therapies restrict the current management to decontamination and symptom-tailored support. This manuscript will provide an overview of the toxic mechanisms of RCAs, their clinical manifestations, and current therapy after exposure to tear gases.
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Affiliation(s)
- Manuel E. Quiroga-Garza
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Jose L. Sevilla-Llorca
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States,*Correspondence: Victor L. Perez,
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Szallasi A. Dietary Capsaicin: A Spicy Way to Improve Cardio-Metabolic Health? Biomolecules 2022; 12:biom12121783. [PMID: 36551210 PMCID: PMC9775666 DOI: 10.3390/biom12121783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Today's sedentary lifestyle with too much food and too little exercise has made metabolic syndrome a pandemic. Metabolic syndrome is a major risk factor for type-2 diabetes and cardiovascular disease. New knowledge of medical and nutraceutical intervention in the early stages of metabolic syndrome is central to prevent these deadly complications. People who eat chili pepper on a regular basis seem to stay healthier and live longer than those who do not. Animal experiments suggest a therapeutic potential for dietary capsaicin, the active principle in hot chili pepper, to reduce the risk of developing metabolic syndrome. This is an attractive theory since capsaicin has been a culinary staple for thousands of years, and is generally deemed safe when consumed in hedonically acceptable doses. The broad expression of the capsaicin receptor TRPV1 in metabolically active tissues lends experimental support to this theory. This review critically evaluates the available experimental and clinical evidence for and against dietary capsaicin being an effective dietary means to improve cardio-metabolic health. It comes to the conclusion that although a chili pepper-rich diet is associated with a reduced risk of dying due to cardiovascular disease, dietary capsaicin has no clear effect on blood glucose or lipid profiles. Therefore, the reduced mortality risk may reflect the beneficial action of digested capsaicin on gut microbiota.
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Affiliation(s)
- Arpad Szallasi
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
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6
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Pathogenesis and treatment principles ocular damage by self-defense gas weapons. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov105683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The article presents the pathogenetic mechanisms of eye damage by gas self-defense weapons in detail. We discuss the mechanisms of eye damage and structural changes of the tissues after gas-trauma. The causes of these changes and the main clinical manifestations accompanying them are analyzed. We analyzed the factors, influencing the development of dystrophic changes of the ocular surface in detail. The information on various techniques for self-assistance, mutual aid and earlier specific treatment of this injury was summarized. An aqueous solution of pediphene substance promising for use is considered, which has a number of pharmacological properties that fundamentally affect the pathogenetic mechanisms of gas-weapon trauma. Its effectiveness was shown in the experiment in comparison with the control group without treatment and the group using the combined drug-dexamethasone in combination with an antibiotic.
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Borges J, Sautier C, Krebs-Drouot L, Henry P, Paysant F, Scolan V. Death and non-lethal weapons: A case of homicide by penetrating injury without projectile. Forensic Sci Int 2022; 337:111374. [PMID: 35839685 DOI: 10.1016/j.forsciint.2022.111374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/09/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Abstract
Herein, we report the death of a man, approximately thirty years old, victim of a short-range shot to the thorax from a PIEXON JPX4, a hand weapon classed category D in France, said to be non-lethal. External examination of the lesion revealed characteristics similar to those of ballistic injuries. The autopsy found an intercostal wound that reached the pulmonary parenchyma and the pulmonary artery, with severe hemothorax. By the end of the autopsy, no projectile had been found in the body, nor any exit orifice. Death was caused by the effects of hemorrhagic shock. The PIEXON JPX4 has four cartridges, projecting a capsaicin gel that is designed to irritate the ENT area (ear nose throat) to incapacitate an assailant. The manufacturer recommends not to use it at distances of less than 1.5 m. Experimental shots were performed on gelatine blocks at point-blank range and at distances of 5, 10, 20, 30, 50, 100 and 150 cm to evaluate the distance necessary for the jet of gel to have a penetrating effect. Shots at 5-30 cm penetrated the structure. None of the other shots were penetrating. The autopsy and experiment data therefore show the penetrating potential of the jet of gel. Herein, we report the first death due to use of the PIEXON JPX4. From a forensic investigation viewpoint, we add a new exception to the "bullet rule". (The odd and even bullet rule states that if the number of gunshot wounds of entrance and exit found in the body is even, the presumption is that no bullet is lodged in the body. If the number of gunshot wounds of entrance and exit is odd, the presumption is that one or more bullets have been lodged in the body.).
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Affiliation(s)
- J Borges
- Service de médecine légale, CHU de Grenoble, France.
| | | | | | - P Henry
- Service de médecine légale, CHU de Grenoble, France
| | - F Paysant
- Service de médecine légale, CHU de Grenoble, France
| | - V Scolan
- Service de médecine légale, CHU de Grenoble, France
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Effect of 5-Amino-1H-Tetrazole on Combustion Pyrolysis Characteristics and Kinetics of a Combustion Tear Gas Mixture. CRYSTALS 2022. [DOI: 10.3390/cryst12070948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Taking the combustion tear gas mixture as the research object, the system formula was optimized by adding a different mass fraction of 5-amino-1H-tetrazole(5AT). TG-DSC, a thermocouple, and a laser smoke test system were used to characterize the characteristic combustion parameters such as combustion temperature and velocity, as well as the end-point effects such as smoke concentration and particle size. Starink’s method, the Flynn–Wall–Ozawa method, and the Coats–Redfern method were used to evaluate the pyrolysis kinetic parameters of the samples. The results show that when the mass fraction of 5-amino-1H-tetrazole in the system is 10%, the maximum combustion temperature of the sample decreases by nearly 70 °C and the smoke concentration increases by 12.81%. The kinetic study also found that with a different mass fraction of 5-amino-1H-tetrazole in the system, the main reaction model of the mixed agent in the first, third, and fourth stages of pyrolysis changed significantly, but for the second stage of sample pyrolysis, the main reaction model (the A4 model) showed a high degree of consistency, which can be considered as the thermal diffusion stage of the tear agent capsicum oleoresin (OC) (the temperature range is 220~350 °C), which is highly consistent with the results of the TG-DSC analysis. It was also confirmed that OC’s thermal diffusion is mainly concentrated in this stage. The results of this study show that adding an appropriate amount of the combustible agent 5-amino-1H-tetrazole to the combustion tear gas mixture can improve its combustion performance and smoking performance, which provides an important, new idea for the development of a new generation of safe, efficient, and environmentally friendly tear gas mixtures.
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Chaudhary MJ, Richardson J. Violence Against Black Lives Matter Protestors: a Review. CURRENT TRAUMA REPORTS 2022; 8:96-104. [PMID: 35669314 PMCID: PMC9136198 DOI: 10.1007/s40719-022-00228-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review The Black Lives Matter (BLM) protests against racialized police violence represents the most prolific mass social movement in modern times. It has been met by sustained and repressive violence by state authorities and right-wing groups. This review seeks to synthesize existing scholarly, journalistic, case report, and crowd sourced data on violence directed against BLM protestors. Recent Findings Data from various sources suggests that police disproportionately target BLM protests for violent intervention. There is also mounting evidence of organized and vigilante right-wing violence targeting BLM protestors. While police frequently use chemical irritants and projectiles, right-wing protestors often use car ramming to bluntly injure protestors. The true scale and nature of injuries affecting BLM protestors remains unknown though injuries resulting in the need for intensive care, operative intervention, permanent morbidity, and mortality have been reported. Summary State and conservative civilian violence against BLM protestors represents an ongoing threat to the right to organize and publicly dissent. The use of force manifested by police and right-wing groups against BLM protestors resulted in significant injury and mortality.
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Affiliation(s)
- Mihir J. Chaudhary
- Department of Surgery, University of California San Francisco – East Bay, 1411 E 31st Street, Oakland, CA 94602 USA
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Quigley A, Nguyen PY, Stone H, Heslop DJ, Chughtai AA, MacIntyre CR. Estimated Mask Use and Temporal Relationship to COVID-19 Epidemiology of Black Lives Matter Protests in 12 Cities. J Racial Ethn Health Disparities 2022; 10:1212-1223. [PMID: 35543865 PMCID: PMC9092928 DOI: 10.1007/s40615-022-01308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022]
Abstract
There is an increased risk of SARS-CoV-2 transmission during mass gatherings and a risk of asymptomatic infection. We aimed to estimate the use of masks during Black Lives Matter (BLM) protests and whether these protests increased the risk of COVID-19. Two reviewers screened 496 protest images for mask use, with high inter-rater reliability. Protest intensity, use of tear gas, government control measures, and testing rates were estimated in 12 cities. A correlation analysis was conducted to assess the potential effect of mask use and other measures, adjusting for testing rates, on COVID-19 epidemiology 4 weeks (two incubation periods) post-protests. Mask use ranged from 69 to 96% across protests. There was no increase in the incidence of COVID-19 post-protest in 11 cities. After adjusting for testing rates, only Miami, which involved use of tear gas and had high protest intensity, showed a clear increase in COVID-19 after one incubation period post-protest. No significant correlation was found between incidence and protest factors. Our study showed that protests in most cities studied did not increase COVID-19 incidence in 2020, and a high level of mask use was seen. The absence of an epidemic surge within two incubation periods of a protest is indicative that the protests did not have a major influence on epidemic activity, except in Miami. With the globally circulating highly transmissible Alpha, Delta, and Omicron variants, layered interventions such as mandated mask use, physical distancing, testing, and vaccination should be applied for mass gatherings in the future.
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Affiliation(s)
- Ashley Quigley
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Phi Yen Nguyen
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - Haley Stone
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia
| | - David J Heslop
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW, Level 3, Samuels Building, UNSW, Sydney, NSW, 2052, Australia
| | - C Raina MacIntyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, UNSW, High St, Kensington Campus, Sydney, NSW, 2052, Australia
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The language of less-lethal weapons. Proc Natl Acad Sci U S A 2022; 119:e2117779119. [PMID: 35412863 PMCID: PMC9169936 DOI: 10.1073/pnas.2117779119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
It has been over 1 year since we observed the policing of the George Floyd protests in the United States [R. R. Hardeman, E. M. Medina, R. W. Boyd, N. Engl. J. Med. 383, 197-199 (2020)]. Multiple injury reports emerged in medical journals, and the scientific community called for law enforcement to discontinue the use of less-lethal weapons [E. A. Kaske et al., N. Engl. J. Med. 384, 774-775 (2021) and K. A. Olson et al., N. Engl. J. Med. 383, 1081-1083 (2020)]. Despite progress in research, policy change has not followed a similar pace. Although the reasoning for this discrepancy is multifactorial, failure to use appropriate language may be one contributing factor to the challenges faced in updating policies and practices. Here, we detail how language has the potential to influence thinking and decision-making, we discuss how the language of less-lethal weapons minimizes harm, and we provide a framework for naming conventions that acknowledges harm.
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Chemical Agents Encountered in Protests. Emerg Med Clin North Am 2022; 40:365-379. [DOI: 10.1016/j.emc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Das S, Saha A, Patowary P, Niri P, Goyary D, Karmakar S, Chattopadhyay P. Assessment of toxicological consequences upon acute inhalation exposure to chemically improvised nonlethal riot control combinational formulation (NCF) containing oleoresin capsicum and skatole. Toxicol Res (Camb) 2021; 10:1129-1143. [PMID: 34956616 DOI: 10.1093/toxres/tfab095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022] Open
Abstract
Sensory irritation is an acute adverse effect leading to temporary disability posed by riot control agents in various deployable forms are utilized by defense personal in violent mob attacks but their irreversible toxic effects and risk assessment have been a matter of concern. These intimidating risks of available riot control agents have led to exploring the pulmonary toxicity profile of the oil in water emulsion formulation developed for vicious crowd controls containing an irritant oleoresin capsicum, a malodorant (skatole), and a commercial dye, followed by characterization using standard methods. Nonlethal riot control combinational formulation (NCF) has been aimed to be the best possible low-lethal alternative for riot control measures. In this study, 30 min of acute inhalation exposure of NCF was given to Wistar rats and various respiratory parameters like lung dynamics, bronchoalveolar lavage fluid (BALF) cytological assays, pro-inflammatory cytokines estimation, antioxidant activity, collagen accumulation, cytotoxicity, in vivo lung imaging, western blot, histology of lung tissue, etc. were investigated to validate its potentiality and rate of irritation reversibility as nonlethal agents. An exaggerated physiological change like sensory irritation, changes in lung functional variables, increased pro-inflammatory cytokines, etc. were noticed initially without airway obstruction as the expression of nociceptive TRPV1 protein did not alter the physiological regulation of protective proteins like Nrf2 and HO-1 and also no abnormality was found in lung tissue architecture. In conclusion, it can be stated that this formulation can be explored as a nonlethal riot control agent intending to generate discomfort but with early reversibility of sensory irritation and no recurrence of toxicity.
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Affiliation(s)
- Sanghita Das
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
| | - Achintya Saha
- Department of Chemical Technology, University of Calcutta, 92, A.P.C. Road, Kolkata 700009, India
| | - Pompy Patowary
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
| | - Pakter Niri
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
| | - Danswrang Goyary
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
| | - Sanjeev Karmakar
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
| | - Pronobesh Chattopadhyay
- Division of Pharmaceutical Technology, Defence Research Laboratory, Solmara, Tezpur, Assam 784001, India
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Kahle ME, Hamann KM, Sakher AA, Kaske EA, Pagliara T, Pariser JJ. Testicular rupture following rubber bullet trauma case report. Transl Androl Urol 2021; 10:3529-3531. [PMID: 34532277 PMCID: PMC8421836 DOI: 10.21037/tau-21-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/25/2021] [Indexed: 11/06/2022] Open
Abstract
Following civil unrest during 2020, physicians began to notice a variety of injuries resulting from crowd control weapons. While prior research emphasized ocular trauma, genitourinary complications of injuries have yet to be investigated. A previously healthy 27-year-old male presented to the emergency department due to sudden onset of severe left testicular pain following rubber bullet trauma. Physical exam showed extreme tenderness, abrasion, contusion, and edema of the left testicle with normal right testicle. Doppler ultrasound showed minimal blood flow to the superior pole with irregularity of the tunica albuginea. Surgery confirmed testicular rupture with a large tunical violation and extruded spermatic tubules. The testicle was thoroughly irrigated, non-viable tubules were debrided, and intraoperative ultrasound confirmed restoration of blood flow. Patient was discharged and instructed to follow-up should he face any fertility concerns in the future. Current crowd control guidelines state projectiles should be aimed at the lower abdomen or extremities; however, projectiles can cause testicular trauma which may lead to hypogonadism, infection, and psychological impact. Until there are changes to methods of crowd control, attendees should consider the use of athletic cups.
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Affiliation(s)
- Madison E Kahle
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kayla M Hamann
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Aliya A Sakher
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erika A Kaske
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Travis Pagliara
- Department of Urology, Hennepin Healthcare, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Tear gases, or chemical demonstration control agents (DCA), were originally created as weapons that could severely disable or kill enemy troops. Though banned in war, these chemicals are still used in domestic policing. Here we review the available scientific literature on tear gas, summarizing findings from animal and environmental studies as well describing data from new human studies. We find a lack of scientific evidence supporting the safety of tear gas, especially regarding its long-term impacts on human health and the environment. Many of the available studies were published decades ago, and do not parse data by variables such as chemical type and exposure time, nor do they account for the diversity of individuals who are exposed to tear gas in real-life situations. Due to the dearth of scientific research and the misinterpretation of some of the available studies, we conclude that a serious reevaluation of chemical DCA safety and more comprehensive exposure follow-up studies are necessary.
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Affiliation(s)
- Jennifer L Brown
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Carey E Lyons
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Carlee Toddes
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Timothy Monko
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - Roman Tyshynsky
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
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16
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Liu W, Yu B, Bursztyn L, Malvankar-Mehta MS. Eye injuries sustained during protests due to non-lethal weaponry: a systematic review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1931124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Winnie Liu
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Ontario, Canada
| | - Brian Yu
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Ontario, Canada
| | - Lulu Bursztyn
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
| | - Monali S. Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, the University of Western Ontario, Ontario, Canada
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17
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Eisenman DP, Wiley DJ, Pollock BH, Rutherford GW, Rimoin AW, Bibbins-Domingo K, Checkoway H, Hurd T, Waters CM, Dawson-Rose C. Recommendations for Demonstrators, Law Enforcement Agencies, and Public Health Agencies for Reducing SARS-CoV-2 Transmission During Civil Protests. Public Health Rep 2021; 136:264-268. [PMID: 33593123 PMCID: PMC8580400 DOI: 10.1177/0033354921991939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- David P. Eisenman
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Center for Public Health and Disasters, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Dorothy J. Wiley
- School of Nursing, UCLA Clinical Translational Science Institute, University of California, Los Angeles, CA, USA
| | - Brad H. Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Anne W. Rimoin
- Department of Epidemiology, Center for Global and Immigrant Health, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Harvey Checkoway
- Department of Family Medicine & Public Health, and Department of Neurosciences, University of California, San Diego, CA, USA
| | - Thelma Hurd
- Department of Public Health, University of California, Merced, Merced, CA, USA
| | - Catherine M. Waters
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
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18
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Torgrimson-Ojerio BN, Mularski KS, Peyton MR, Keast EM, Hassan A, Ivlev I. Health issues and healthcare utilization among adults who reported exposure to tear gas during 2020 Portland (OR) protests: a cross-sectional survey. BMC Public Health 2021; 21:803. [PMID: 33902512 PMCID: PMC8074355 DOI: 10.1186/s12889-021-10859-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/16/2021] [Indexed: 01/26/2023] Open
Abstract
Background Repeated use of chemical irritants for crowd-control by local and federal law enforcement during sustained racial justice protests in the U.S. has raised concerns about potential adverse health effects. The objective of this study was to describe the health consequences of exposure to tear gas agents and associated healthcare utilization among adults reporting recent exposure to tear gas. Methods A cross-sectional, self-administered web-based survey of a convenience sample of 2257 adults reporting recent exposure to tear gas in Portland, Oregon (U.S.), administered between July 30, 2020-August 20, 2020. Descriptive analyses were conducted on socioeconomic characteristics, reported health issues, utilization of healthcare services, and frequency of reported exposure to tear gas. Associations between reported mental health issues, healthcare utilization and race and/or ethnic categories were assessed using a chi-square test. For tests of association, racial and/or ethnic categories were divided into White/Non-Hispanic only and all other racial/ethnic categories due to a small number of Black, American Indian or Alaska Native, Asian/Pacific Islander, Hispanic participants and participants with multiple race and/or ethnic background. Effect sizes for the differences were expressed as Cramer’s V, a metric that measures associations between nominal responses. The Cochran-Armitage trend test was used to assess the relationship between health issues and the number of reported days of exposure to tear gas (i.e., a proxy dose of exposure) grouped into 1 day, 2–4 days, and ≥ 5 days. Missing data (item non-response) were omitted from the analysis. Results Almost all respondents (2116; 93.8%) reported physical (2114; 93.7%) or psychological (1635; 72.4%) health issues experienced immediately after (2105; 93.3%) or days following (1944; 86.1%) the exposure. A slightly higher proportion experienced delayed head or gastrointestinal tract issues compared with immediate complaints. The majority (1233; 54.6%) reported receiving or planning to seek medical or mental care. We observed a positive exposure-response trend for all except mouth-related delayed issues (p < 0.01). Conclusion Persons who reported exposer to tear gas agents also reported physical and psychological health issues over a multiple-day period. Health issues reported increased with the frequency of reported exposure, indicating a potential dose-response; these health effects often led to healthcare utilization. This study provides evidence of potential unexpected harms of tear gas in civilians. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10859-w.
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Affiliation(s)
- Britta N Torgrimson-Ojerio
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA.
| | - Karen S Mularski
- Northwest Permanente P.C, 500 NE Multnomah St #100, Portland, OR, 97232, USA
| | - Madeline R Peyton
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Erin M Keast
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Asha Hassan
- University of Minnesota, School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Ilya Ivlev
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
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19
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Kaske EA, Cramer SW, Pena Pino I, Do TH, Ladd BM, Sturtevant DT, Ahmadi A, Taha B, Freeman D, Wu JT, Cunningham BA, Hardeman RR, Satin DJ, Darrow DP. Injuries from Less-Lethal Weapons during the George Floyd Protests in Minneapolis. N Engl J Med 2021; 384:774-775. [PMID: 33440082 DOI: 10.1056/nejmc2032052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Erika A Kaske
- University of Minnesota Medical School, Minneapolis, MN
| | | | | | - Truong H Do
- University of Minnesota Medical School, Minneapolis, MN
| | - Bryan M Ladd
- University of Minnesota Medical School, Minneapolis, MN
| | | | | | - Birra Taha
- University of Minnesota Medical School, Minneapolis, MN
| | - David Freeman
- University of Minnesota Medical School, Minneapolis, MN
| | - Joel T Wu
- University of Minnesota School of Public Health, Minneapolis, MN
| | | | | | - David J Satin
- University of Minnesota Medical School, Minneapolis, MN
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20
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Hiensch RJ. Pulmonary Manifestations of Torture. Chest 2021; 159:2384-2391. [PMID: 33582098 DOI: 10.1016/j.chest.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022] Open
Abstract
Despite international treaties banning torture, it is still widely practiced by state agents and private citizens alike. Pulmonologists may encounter survivors of torture in routine clinical practice or in the context of a forensic medical evaluation. The Istanbul Protocol delineates the general approach to the effective medical examination, investigation, and reporting of an individual alleging torture, but relatively little text is devoted to the specific pulmonary manifestations of torture. This review intends to address this paucity.
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Affiliation(s)
- Robert J Hiensch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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21
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Cortés S, Martínez-Gutiérrez MS, Jiménez SA. [Violation of human rights in the mobilizations of October 2019 in Chile]. GACETA SANITARIA 2021; 35:399-401. [PMID: 33573810 DOI: 10.1016/j.gaceta.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/15/2022]
Abstract
Chile's October 2019 popular revolt has again made human rights violations visible in the context of mass mobilizations. In terms of damage to the population's health, multiple eye injuries produced by kinetic impact projectiles and tear bombs against people were reported, leading to an outbreak of unpublished eye injuries worldwide. There was excessive use of chemical weapons, and the totality of the chemicals used has not been transparent. The impact on mental health, especially of the population who lived during dictatorship in the 1970s, is uncertain and, health care was overwhelmed in the most vulnerable geographic areas. It is urgent to establish a timely and transparent system for monitoring such lesions and transparent all chemical compounds in tear-tearing and the composition of kinetic impact projectiles.
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Affiliation(s)
- Sandra Cortés
- Departamento de Salud Pública, Centro de Desarrollo Urbano Sustentable CEDEUS, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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22
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El Zahran T, Mostafa H, Hamade H, Mneimneh Z, Kazzi Z, El Sayed MJ. Riot-related injuries managed at a hospital in Beirut, Lebanon. Am J Emerg Med 2021; 42:55-59. [PMID: 33453616 DOI: 10.1016/j.ajem.2020.12.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/05/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Between October 2019 and February 2020, massive crowds protested in Lebanon against economic collapse. Various less than lethal weapons including riot control agents and rubber bullets were used by law enforcement, which led to several traumatic and chemical injuries among victims. This study describes the clinical presentation, management, outcome, and healthcare costs of injuries. METHODS A retrospective review of the hospital records of all the casualties presenting to the Emergency Department of the American University of Beirut Medical Center between October 17th, 2019, and February 29th, 2020, was conducted. RESULTS A total of 313 casualties were evaluated in the ED, with a mean age of 30.2 +/- 9.6 years and a predominance of males (91.1%). Most were protestors (71.9%) and arrived through EMS (43.5%) at an influx rate of one patient presenting every 2.7-8 min. Most patients (91.1%) presented with an Emergency Severity Index of 3. Most patients (77.6%) required imaging with 10% having major findings including fractures and hemorrhages. Stones, rocks, and tear gas canisters (30.7%) were the most common mechanism of injury. Musculoskeletal injuries were most common (62.6%), followed by lacerations (44.7%). The majority (93.3%) were treated and discharged home and 3.2% required hospital admission, with 2.6% requiring surgery. CONCLUSION Less-than-lethal weapons can cause severe injuries and permanent morbidity. The use of riot control agents needs to be better controlled, and users need to be well trained in order to avoid misuse and to lessen the morbidity, mortality, and financial burden.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hala Mostafa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Mneimneh
- Quality Accreditation and Risk Management Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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23
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Lechner A, Alderson T, Gautam S, Flaker G. Ventricular fibrillation due to coronary spasm after pepper spray. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:548-551. [PMID: 33368435 DOI: 10.1111/pace.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 12/29/2022]
Abstract
Pepper spray is used as a crowd control agent and for self-defense. It has been thought to be safe; however, 27 persons have died in police custody after exposure to pepper spray. We report on a 21-year-old man, with no underlying heart disease and a normal ECG and echocardiogram in the past, who was pepper sprayed and developed ventricular fibrillation. An admission ECG showed marked ST segment elevation but subsequent coronary arteriography was normal. We hypothesize that pepper spray triggered coronary spasm, resulting in ventricular fibrillation. This report adds to a body of information that pepper spray is dangerous.
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Affiliation(s)
- Adam Lechner
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Tyler Alderson
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Greg Flaker
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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24
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Bloom WR, Bloom TD. Epidemiology of Eye Injuries Caused by Personal Protection Devices and Kinetic Impact Projectile Weapons. JAMA Ophthalmol 2020; 138:1318-1319. [PMID: 33119052 DOI: 10.1001/jamaophthalmol.2020.4434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William R Bloom
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Thomas D Bloom
- Madison Medical Eye Care, Madison Medical Affiliates, Milwaukee, Wisconsin
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25
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In Response to: Epidemiology of security forces injuries during training for maintaining and restoring order. J Trauma Acute Care Surg 2020; 89:e190-e191. [DOI: 10.1097/ta.0000000000002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Serchen J, Doherty R, Atiq O, Hilden D. Racism and Health in the United States: A Policy Statement From the American College of Physicians. Ann Intern Med 2020; 173:556-557. [PMID: 32559145 DOI: 10.7326/m20-4195] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Racial minorities in the United States have reported experiencing widespread racism throughout all aspects of life, from housing to education to employment. Existing research has examined the role of racism, discrimination, and violence in one's interaction with the health care system and their association with poorer mental and physical health. Systemic racism that underlies the fabric of society often manifests itself in prominent institutions, such as law enforcement agencies, regardless of individual intent. Overt and covert racist laws and policies, personal implicit biases, and other factors result in Black individuals and other people of color being the subject of law enforcement violence and criminal justice system interactions at disproportionately high rates. The demonstrated association between discriminatory law enforcement practices and violence and personal and community health necessitates treating these issues as public health issues worthy of a public policy intervention. Addressing some of the sources of institutional racism and harm through transparency and accountability measures is the first of many steps required to begin correcting historical racial injustices.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S., R.D.)
| | - Robert Doherty
- American College of Physicians, Washington, DC (J.S., R.D.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- University of Minnesota Medical School, Minneapolis, Minnesota (D.H.)
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27
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Horowitz BZ. Tear gas in America: Cry the Beloved Country. TOXICOLOGY COMMUNICATIONS 2020. [DOI: 10.1080/24734306.2020.1817660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- B. Zane Horowitz
- Department of Emergency Medicine, Oregon Poison Center, Oregon Health & Science University, Portland, OR, USA
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28
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Gaffney AW, McCormick D, Woolhandler S, Himmelstein DU. US law enforcement crowd control tactics at anti-racism protests: a public health threat. Lancet 2020; 396:21. [PMID: 32569581 PMCID: PMC7304962 DOI: 10.1016/s0140-6736(20)31421-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Adam W Gaffney
- Cambridge Health Alliance, Cambridge, MA 02138, USA; Harvard Medical School, Boston, MA, USA.
| | - Danny McCormick
- Cambridge Health Alliance, Cambridge, MA 02138, USA; Harvard Medical School, Boston, MA, USA
| | - Steffie Woolhandler
- Harvard Medical School, Boston, MA, USA; City University of New York at Hunter College, New York, NY, USA
| | - David U Himmelstein
- Harvard Medical School, Boston, MA, USA; City University of New York at Hunter College, New York, NY, USA
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29
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Lassen CL, Meyer K, Bredthauer A, Klier TW. Facial and Oral Cross-Contamination of a 3-Year-Old Child With High Concentration Capsaicin: A Case Report. A A Pract 2020; 14:e01258. [DOI: 10.1213/xaa.0000000000001258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Heisler M, Mishori R, Haar R. Protests Against Police Violence Met by More Police Violence—A Dangerous Paradox. JAMA HEALTH FORUM 2020; 1:e200739. [DOI: 10.1001/jamahealthforum.2020.0739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michele Heisler
- Physicians for Human Rights, New York, New York
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Ranit Mishori
- Physicians for Human Rights, New York, New York
- Georgetown University School of Medicine, Washington, DC
| | - Rohini Haar
- Physicians for Human Rights, New York, New York
- School of Public Health, University of California, Berkeley
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31
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Calumpang CLF, Saigo T, Watanabe M, Tohge T. Cross-Species Comparison of Fruit-Metabolomics to Elucidate Metabolic Regulation of Fruit Polyphenolics Among Solanaceous Crops. Metabolites 2020; 10:E209. [PMID: 32438728 PMCID: PMC7281770 DOI: 10.3390/metabo10050209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/03/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022] Open
Abstract
Many solanaceous crops are an important part of the human daily diet. Fruit polyphenolics are plant specialized metabolites that are recognized for their human health benefits and their defensive role against plant abiotic and biotic stressors. Flavonoids and chlorogenates are the major polyphenolic compounds found in solanaceous fruits that vary in quantity, physiological function, and structural diversity among and within plant species. Despite their biological significance, the elucidation of metabolic shifts of polyphenols during fruit ripening in different fruit tissues, has not yet been well-characterized in solanaceous crops, especially at a cross-species and cross-cultivar level. Here, we performed a cross-species comparison of fruit-metabolomics to elucidate the metabolic regulation of fruit polyphenolics from three representative crops of Solanaceae (tomato, eggplant, and pepper), and a cross-cultivar comparison among different pepper cultivars (Capsicum annuum cv.) using liquid chromatography-mass spectrometry (LC-MS). We observed a metabolic trade-off between hydroxycinnamates and flavonoids in pungent pepper and anthocyanin-type pepper cultivars and identified metabolic signatures of fruit polyphenolics in each species from each different tissue-type and fruit ripening stage. Our results provide additional information for metabolomics-assisted crop improvement of solanaceous fruits towards their improved nutritive properties and enhanced stress tolerance.
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Affiliation(s)
| | | | | | - Takayuki Tohge
- Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), Ikoma, Nara 630-0192, Japan; (C.L.F.C.); (T.S.); (M.W.)
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32
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Hoz SS, Aljuboori ZS, Dolachee AA, Al-Sharshahi ZF, Alrawi MA, Al-Smaysim AM. Fatal Penetrating Head Injuries Caused by Projectile Tear Gas Canisters. World Neurosurg 2020; 138:e119-e123. [PMID: 32081822 DOI: 10.1016/j.wneu.2020.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since their advent in the 1920s, tear gas canisters (TGCs) have been frequently used in crowd control. Few reports have documented nonpenetrating injuries attributed directly to TGCs. In this study, we report a case series of fatal penetrating head injuries caused by TGCs. METHODS We conducted a retrospective chart review of all the patients who were admitted to the Neurosurgery Teaching Hospital in Baghdad, Iraq, since the start of the antigovernment protests (October 2019). All patients who suffered penetrating head trauma caused by TGCs were included in our study. We collected patient demographics, wound location, neurologic examination, computed tomography (CT) scan findings, surgical management, and clinical outcomes. RESULTS We found 10 cases of penetrating head trauma caused by TGCs. All victims were men, with a mean age of 16 years (range, 14-19 years). The mean Glasgow Coma Scale score was 7 (range, 3-10). The neurologic examination revealed unilateral hemiplegia/hemiparesis and pupillary abnormality in 40% (n = 4) and 50% (n = 5) of the patients, respectively. CT scans revealed an extensive pattern of brain damage. Surgical intervention was done in 80% of cases (n = 8), which included removal of the TGC, wound debridement, and hemostasis. The in-hospital mortality rate was 100% (N = 10), with all fatalities occurring within 1-3 days of admission. CONCLUSIONS TGCs have the potential to cause lethal penetrating head injuries, calling for a reevaluation of their safety and methods of use in terms of human health.
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Affiliation(s)
- Samer S Hoz
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Zaid S Aljuboori
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA.
| | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | | | - Mohammed A Alrawi
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Ammar M Al-Smaysim
- Department of Neurological Surgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Chan EYY, Hung KKC, Hung HHY, Graham CA. Use of tear gas for crowd control in Hong Kong. Lancet 2019; 394:1517-1518. [PMID: 31623895 DOI: 10.1016/s0140-6736(19)32326-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, School of Public Health and Primary Care, Prince of Wales Hospital, Sha tin, Hong Kong.
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Sha tin, Hong Kong
| | - Heidi Hoi Yi Hung
- School of Public Health and Primary Care, Prince of Wales Hospital, Sha tin, Hong Kong
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Sha tin, Hong Kong
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Satpute RM, Kushwaha PK, Nagar DP, Rao PVL. Comparative safety evaluation of riot control agents of synthetic and natural origin. Inhal Toxicol 2019; 30:89-97. [PMID: 29595092 DOI: 10.1080/08958378.2018.1451575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Riot control agents (RCA) are lachrymatory, irritating compounds which temporarily incapacitate the uncontainable crowd. Ortho-Chlorobenzylidene-malononitrile (CS), 2-chloroacetophenone (CN), dibenz[b,f]1:4-oxazepine (CR), and nonivamide (PAVA) are synthetic RCAs, while oleoresin extract of chili known as oleoresin capsicum (OC) a natural irritant has been in use by various law enforcement agencies. Though efficacy of these agents is beyond doubt, they suffer from certain drawbacks including toxicity, production cost, and ecological compatibility. Presently, we have evaluated the safety of CR, OC, and PAVA on inhalation variables along with oral lethality. Additionally, the liver function test (LFT) in serum and lungs function was evaluated in broncho-alveolar-lavage fluid (BALF), both collected on the 14th day after RCA exposure. Animals then sacrificed and histopathology of liver and lungs was carried out. Results showed OC and PAVA to be more toxic than CR with an oral LD50 of 150 and 200 mg/kg body weight, respectively, while CR was safe at >3 g/kg body weight. All three agents caused severe impairment of respiratory variables bringing down normal respiration by >80% with rise in sensory irritation. Recovery from the irritating effect of CR was more rapid than OC and PAVA. LFT and BALF variables were not significantly different from that of control. There were no remarkable histopathological changes in liver and lungs. Hence, as per results, CR is safest among all synthetic and natural origin RCAs and can be safely used for effective dispersion of disobedient mob.
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Affiliation(s)
- Ravindra M Satpute
- a Toxicology Laboratory , Defence Research & Development Establishment , Nagpur , India
| | - Pramod K Kushwaha
- b Division of Pharmacology & Toxicology , Defence Research and Development Establishment , Gwalior , India
| | - D P Nagar
- b Division of Pharmacology & Toxicology , Defence Research and Development Establishment , Gwalior , India
| | - P V L Rao
- a Toxicology Laboratory , Defence Research & Development Establishment , Nagpur , India
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Antonio AS, Wiedemann LSM, Veiga Junior VF. The genus Capsicum: a phytochemical review of bioactive secondary metabolites. RSC Adv 2018; 8:25767-25784. [PMID: 35539808 PMCID: PMC9082723 DOI: 10.1039/c8ra02067a] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022] Open
Abstract
The Capsicum genus is one of the most popular plants consumed and cultivated worldwide, containing approximately 50 000 varieties of pepper. Due to its wide biodiversity, the chemical composition within the genus also presents a great variability. Its major applications are in food and pharmacological industry, as pepper presents a chemical composition rich in capsaicinoids, carotenoids, flavonoids and volatile compounds which is attributed to the ability of the fruit to remove insipidity, produce aromas and act against oxidative diseases. Due the existence of several cultivars there is a huge intraspecific chemical variability within each species, which can be considered as an obstacle when selecting and cultivating a species to be applied as a natural product source for a specific objective. The usage of pepper-based products in different industrial areas requires pre-established ranges of chemical compounds, such as capsaicinoids, which in high concentration are toxic when consumed by humans. Applying a pepper with a chemical profile closely related to the concentration that is required after industrial processing can improve efficacy and effectiveness of the process. An insight into the chemical characteristics of major secondary bioactive compounds within Capsicum, the factors that affect their concentration and their chemosystematic implication are reported and discussed.
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Affiliation(s)
- A S Antonio
- Chemistry Department, Institute of Exact Sciences, Amazonas Federal University Avenida Rodrigo Octávio, 6200, Coroado, CEP: 69.077-000 Manaus AM Brazil
| | - L S M Wiedemann
- Chemistry Department, Institute of Exact Sciences, Amazonas Federal University Avenida Rodrigo Octávio, 6200, Coroado, CEP: 69.077-000 Manaus AM Brazil
| | - V F Veiga Junior
- Chemistry Department, Institute of Exact Sciences, Amazonas Federal University Avenida Rodrigo Octávio, 6200, Coroado, CEP: 69.077-000 Manaus AM Brazil
- Chemistry Section, Military Institute of Engineering Praça General Tibúrcio, 80, Praia Vermelha, Urca, CEP: 22.290-270 Rio de Janeiro RJ Brazil
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[Physical and chemical emergencies in dermatology]. Hautarzt 2018; 69:376-383. [PMID: 29500476 DOI: 10.1007/s00105-018-4137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Physical and chemical emergencies are often caused by household or work accidents. Regardless of the medical field and outside specialized clinics, the physician may be confronted with the situation for first or secondary care. The identification of the causing agent and a rapid assessment of the extent and severity of the tissue damage are essential to initiate early transfer to a specialized burn clinic. Grade 2b tissue damage is usually surgically treated. Smaller and superficial injuries can often be conservatively treated. Even supposedly safe and over-the-counter medicines can also lead to serious tissue damage.
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