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Penetrating cardiac injuries are rare but are one of the most urgent emergencies because they require early intervention in order to prevent death. The mortality rate of such injuries, including pre-hospitalization deaths, goes up to 90%. The most commonly injured heart chamber is the right ventricle since it takes over half of the anterior thoracic wall. The left ventricle is injured less often, but these patients usually have worse prognoses and higher mortality rates because such injuries lead to hemodynamic instability faster. We present a unique case of a suicide attempt in which the patient stabbed himself with a knife, penetrated the left ventricle, and survived even though he transected the second diagonal branch of the left anterior descending coronary artery and pulled the knife out of his chest. [ABSTRACT FROM AUTHOR]

Trauma management forms a significant component of any health system. It can affect any body system, and as such knowledge of the wide possible presentations and sequalae are critical. Systemic air embolism (SAE) is a rare presentation in trauma, though it can be associated with significant morbidity and mortality. We present the case of a 23-year-old gentleman with isolated penetrating trauma to the chest who developed widespread neurological insult as a result of SAE, and review historical and proposed contemporary management of SAE. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.Materials and Methods: The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.Results: We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).Conclusion: We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution. [ABSTRACT FROM AUTHOR]

Objectives: The treatment of wounds accounts for a considerable fraction of health expenses as well as serious socioeconomic problems. The use of natural substances stands out as a source of new therapeutic discoveries for the wound healing. Thus, this review compiled scientific findings on the applicability of carvacrol and thymol, or essential oils containing at least one of these compounds, for the treatment of wounds. Methods: This review was performed at PubMed, SCOPUS, Web of Science databases using keywords as wound healing, thymol/carvacrol and essential oils. Thirteen studies were selected for discussion. Key findings: Thymol/carvacrol was able to act in the three phases of wound healing. In the first phase, they showed modulatory effect of the inflammatory cytokines, oxidative stress and antimicrobial power. In the second phase, they promoted re‐epithelialization, angiogenesis and development of granulation tissue. Finally, in the third phase, they improve the collagen deposition and modulated the growth of fibroblasts and keratinocytes. Conclusions: These compounds present a high potential for the development of new therapeutic for wound repair. However, dose, efficacy and safety of these compounds for the treatment of wounds, as well as the mechanisms by which those effects can be observed, are challenges for future studies. [ABSTRACT FROM AUTHOR]

Background: Mechanisms for military injury have evolved in the past century. Debridement is the gold standard for preparing a clean wound bed, decreasing the bacterial load, and reducing the likelihood of infection. However, bacteria may continue to linger in these wounds. The MolecuLight i:X Imaging Device uses the principle of autofluorescence to detect bacteria under violet light. Thus, visualizing bacteria will not only guide clinicians in their management of the wound but it will also serve as a means of evaluating debridement efforts. We hope to improve traumatic wound management by targeting debridement and assessing its quality.Methods: We describe the use of the MolecuLight i:X to photograph wounds under standard and violet light in three patients. Images were captured before and after debridement. Microbiology swabs were collected to correlate the bacteria found in the images to the wounds.Results: The post-debridement images demonstrate a marked decrease or complete removal of bacteria. The microbiology swabs confirmed the pre-debridement presence of bacteria.Conclusions: The MolecuLight i:X shows promise for debridement evaluation. The use of the MolecuLight i:X may reduce the likelihood of infection, thus having positive implications for military and trauma wounds. [ABSTRACT FROM AUTHOR]

Objectives Whole plants of Boerhavia diffusa L. are widely used medicine in Ghana and other tropical countries, for the treatment of wounds and other ailments. The aim of the study was to determine the ability of sequential extracts of B. diffusa to influence oxidation and wound closure in myoblast cells in vitro. Methods Sequential extracts were prepared from the whole plant using four solvents of increasing polarity (hexane, ethyl acetate, methanol and water). Cytotoxicity was determined using the sulforhodamine B staining assay, phase-contrast microscopy, plas DIC microscopy and live-dead staining. Extracts were tested for their ability to reduce 2,2′-azobis(2-amidinopropane) dihydrochloride ( AAPH)-induced oxidation and mediate cell migration after artificial wound generation in C2C12 myoblast cells using the scratch wound assay. Key findings All extracts indicated negligible cytotoxicity ( IC50 > 100 μg/ml), and microscopic evaluation showed no difference from negative controls. AAPH induced a 2.87-fold increase in reactive oxygen species compared to the negative control. Pretreatment with 100 μg/ml of the extracts reduced AAPH-induced oxidation to 1.70-fold of the untreated controls ( P < 0.001). Wound closures in the methanol and water extract treatments were 18.08% and 20.76% higher than the negative control, respectively ( P < 0.01). Conclusions These findings indicate that the hexane, methanol and water extracts of B. diffusa whole plant promote artificial wound healing and protection against oxidation in vitro and therefore warrant further research into its mechanisms of wound healing. [ABSTRACT FROM AUTHOR]

Background Native Americans are overrepresented in outbreaks of Group A Streptococcus (GAS) in the United States (US). In 2016, several invasive cases of GAS were detected at the Whiteriver Indian Health Service (IHS) Hospital in Arizona that primarily serves the White Mountain Apache (WMA) Tribe. The objective of this study was to determine the burden of invasive and severe GAS disease among Native Americans on the WMA Tribal lands. Methods Prospective population and laboratory-based surveillance for invasive and severe GASinfections was conducted for two years from March 2017 through February 2019. A case was defined as a Native American individual living on or around WMA Tribal lands with GAS isolated from a normally sterile body site (invasive) or from a non-sterile site (e.g. wound, throat, ear) requiring hospitalization (severe). Incidence rates were calculated using the IHS User Population as the denominators. Age-standardized incidence rates were calculated using US Census data from 2015 as the reference group. Results 157 cases were identified (Year 1: 85; Year 2: 72), including 42 (27%) invasive and 115 (73%) severe cases. Most cases were adults (88.5%; median age: 40.5 years) and had ≥1 underlying medical condition (99.4%), including alcoholism (57.1%), hypertension (37.2%), and diabetes (34.0%). 47.8% of cases had a trigger in the past two weeks, including penetrating trauma (31.8%) and blunt force trauma (14.0%). For 72.9% of cases, a co-infection was detected (most commonly Staphylocccus aureus : 96.8%). 4.5% of cases required amputation and 1.9% died within 30 days of initial culture. The incidence of invasive and severe GAS was 460.9 per 100,000 persons (95% confidence interval: 394.3, 538.8), with no significant difference by year. The incidence was highest among adults ≥65 and lowest among children 5–17 years of age. Age-standardized incidence rates of invasive and severe GAS and invasive only GAS are presented in the Figure. Conclusion The WMA community has experienced disproportionately high rates of invasive and severe GAS for over two years. Studies to determine the reservoirs for transmission are urgently needed, as are interventions to reduce the morbidity and mortality associated with these infections. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

We describe a patient who sustained a penetrating injury to the posterior right lower extremity just above the popliteal region with transection of the superficial femoral artery (SFA) despite minimal evidence of active bleeding. An on-table angiogram identified flow in the SFA followed by the popliteal artery and into the trifurcation of the right lower extremity. Eventually, a second operation revealed transection followed by end-to-end anastomosis of SFA and stabilization of the patient. The findings of this case highlight the need for a high index of suspicion and persistent clinical investigation to identify vascular injuries in the absence of hard signs of vascular trauma. [ABSTRACT FROM AUTHOR]