The impact of musculoskeletal injuries sustained in road traffic crashes on work-related outcomes: a protocol for a systematic review

Topical application of a TRPA1 antagonist reduced nociception and inflammation in a model of traumatic muscle injury in rats

Musculoskeletal pain is a widely experienced public healthcare issue, especially after traumatic muscle injury. Besides, it is a common cause of disability, but this pain remains poorly managed. However, the pathophysiology of traumatic muscle injury-associated pain and inflammation has not been fully elucidated. In this regard, the transient receptor potential ankyrin 1 (TRPA1) has been studied in inflammatory and painful conditions. Thus, this study aimed to evaluate the antinociceptive and anti-inflammatory effect of the topical application of a TRPA1 antagonist in a model of traumatic muscle injury in rats. The mechanical trauma model was developed by a single blunt trauma impact on the right gastrocnemius muscle of Wistar male rats (250-350 g). The animals were divided into four groups (Sham/Vehicle; Sham/HC-030031 0.05%; Injury/Vehicle, and Injury/HC-030031 0.05%) and topically treated with a Lanette® N cream base containing a TRPA1 antagonist (HC-030031, 0.05%; 200 mg/muscle) or vehicle (Lanette® N cream base; 200 mg/muscle), which was applied at 2, 6, 12, 24, and 46 h after muscle injury. Furthermore, we evaluated the contribution of the TRPA1 channel on nociceptive, inflammatory, and oxidative parameters. The topical application of TRPA1 antagonist reduced biomarkers of muscle injury (lactate/glucose ratio), spontaneous nociception (rat grimace scale), inflammatory (inflammatory cell infiltration, cytokine levels, myeloperoxidase, and N-acetyl-β-D-glucosaminidase activities) and oxidative (nitrite levels and dichlorofluorescein fluorescence) parameters, and mRNA Trpa1 levels in the muscle tissue. Thus, these results demonstrate that TRPA1 may be a promising anti-inflammatory and antinociceptive target in treating muscle pain after traumatic muscle injury.

The impact of major occupational injuries on professional reintegration. A Portuguese medico-legal contribution

Occupational injuries represent an enormous economic impact for victims, respective families, involved institutions and all the community due to professional outcomes. Thus, it is of the utmost importance that medico-legal personal injury assessment and the posterior follow-up of these victims, may allow their concrete damage repair, considering the victims' needs fulfilment and professional reintegration, whenever possible. The main objective of this study is to reflect on the role that legal medicine can play in promoting the professional reintegration of victims of major occupational accidents through the analysis of occupational injuries cases considering the medico-legal examinations performed. A retrospective study was conducted using medico-legal major occupational injuries cases (Partial Permanent Disability ≥40%). Data were collected from two medico-legal assessment moments: (a) personal injury assessment homologated by a labour court 4.8 years on average after occupational injury; (b) medico-legal follow-up for needs and/or Partial Permanent Disability adjustments performed 18.9 years on average after occupational injury. The final sample includes 103 cases. The results showed that in major occupational accidents, permanent long-term outcomes were principally associated with neurological (62.1%) and orthopaedic (52.4%) sequelae. Permanent professional damage parameters assigned by the labour court included Partial Permanent Disability (23.3%), Permanent Absolute Disability for Regular Work (41.7%) and Permanent Absolute Disability for Any Work (35%). Three-dimensional methodology is helpful in predicting Partial Permanent Disability and Permanent Absolute Disability for Any Work. However, three-dimensional methodology did not reveal correlations with Permanent Absolute Disability for Regular Work, and currently 65% of the victims who were considered able to work by the labour court are not professionally active. Thus, these major cases deserve a more detailed medico-legal approach based on concrete information about the professional reality of each victim, especially cases with an eventual Permanent Absolute Disability for Regular Work. Medico-legal Injury Assessment must be based on concrete aspects of the victim's professional reality and not only on permanent disability tables. This calls for an articulation between all institutions working with the victim of occupational injuries and legal medicine to promote recovery and the necessary measures to assure professional rehabilitation.

The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.

Musculoskeletal symptoms and presentism among professionals of public health management of Belem-PA, Brazil

Introduction: Work-related musculoskeletal disorders affect the performance of workers and can increase presenteeism, a condition in which the employee comes to the workplace but does not produce satisfactory results because he is ill. Objective: To identify the prevalence of musculoskeletal symptoms and its association with presenteeism among public health management professionals of Belem-PA, Brazil. Methods: Cross-sectional study carried out with 88 professionals from the Municipal Health Department of Belem. A sociodemographic questionnaire was used to characterize the sample; the Nordic Musculoskeletal Questionnaire to identify the prevalence of pain, numbness, and tingling symptoms in the body; and the Stanford Presenteeism Scale to characterize presenteeism. Associations between variables were analyzed using a 5% significance level. Results: Musculoskeletal symptoms in the upper and lower back were the most prevalent. Presenteeism was significantly associated with daily workload, physical activity, and the presence of diagnosed musculoskeletal diseases or injuries. In the past 12 months, musculoskeletal symptoms in the neck, upper and lower back, wrists/hands, and hips/thighs have been associated with presenteeism. In the past 7 days, presenteeism has been associated with symptoms in the upper back and lower back. Conclusion: The most prevalent musculoskeletal disorders in health management professionals are associated with presenteeism.

Influence of strain rate on the mechanical behavior of dry and hydrated chitosan-based dense materials for bioabsorbable implant applications

Chitosan has generated enormous interest in the scientific community because of its distinctive biological and physicochemical properties, which allow new advanced structures and applications. Porous chitosan scaffolds have been extensively studied and explored in bone generation, however it is still a challenge to obtain bioabsorbable orthopedic implants that involves pure 3D dense chitosan geometries due to the inherent difficulties in producing and shaping such structures. In this work, chitosan was blended with 10% glycerol and 10% glycerol + 10% biphasic mixture of calcium phosphate (70% hydroxyapatite with 30% β-tricalcium phosphate) to produce dense chitosan-based blocks, which were then shaped into rods. The introduction of plasticizer aimed to improve the materials ductility while the ceramic particles were used to increase stiffness and strength. The mechanical behavior of the two chitosan-based compositions was evaluated by uniaxial compression tests using a customized split-Hopkinson pressure bar (SHPB). The specimens were analysed in quasi-static conditions (less than 0.1 s^-1) and medium strain rate conditions (200-800 s^-1), both in dry state and in different hydrated conditions, in the latter case to approximate the in vivo implant conditions. The results showed promising results for the intended application. The chitosan blends present excellent ductility with an elastic perfect-plastic behavior in quasi-static conditions, with yield stresses around 40 MPa for the dry state, with a decay for 3 MPa after 48h hydration. An empirical model was proposed to describe the flow stress curves, with a good agreement with the experimental data, allowing future modelling of this material behavior.

Isolated Injury to Prepuce After Motor Vehicle Collision

A four-year-old male restrained passenger in the rear seat was in a motor vehicle collision. He had pain and swelling in the tip of the penis with the inability to micturate. The patient on evaluation had an isolated injury of the prepuce. The patient underwent an evaluation to rule out underlying penile/urethra and associated injury of kidney and bladder. The patient had an isolated injury to prepuce, causing urinary retention for which he underwent circumcision.