https://www.clinsurggroup.us/journals/open-journal-of-trauma A Peertechz Open Access Journal en-us 19 Feb, 2026 https://www.clinsurggroup.us/articles/OJT-10-153.php Closed traumatic multiple dislocations of metatarsophalangeal joints (MTP) are uncommon injuries. In the majority of cases described in the literature, open reduction is the treatment for reduction of the dislocation due to the complex anatomy of MTP joints, preventing closed reduction of the affected joints. Our case report describes the dorsoradial dislocation of the second to fifth MTP joints of the left foot following a motor vehicle accident, which was treated by closed manipulation and reduction of the affected joints under anesthesia successfully without external Kirschner wire fixation. Post-reduction, the affected foot was immobilized in a below-knee posterior plaster slab with strapping of the toes for a total of four weeks. At 12 weeks follow-up, the patient had resumed pre-injury activities with a painless range of all lesser toe movements without any radiographic evidence of arthritis on subsequent follow-up at 06 months post-injury. This case highlights that a proper closed manipulation and reduction under anaesthesia is worth trying before embarking on open reduction, as the results of closed reduction are excellent with less morbidity and risks associated with open reduction. 13 Jan, 2026 https://www.clinsurggroup.us/articles/OJT-10-152.php We describe 67 years old male patient presenting with acute coronary syndrome (acute inferior ST elevation) with complete heart block. Primary percutaneous coronary intervention was decided with temporary pacemaker insertion. In view thrombus burden lesion in the proximal right coronary artery. We did thrombus aspiration using a thrombus aspiration catheter. After successfully aspirating thrombus, resistance was felt on withdrawal of the aspiration catheter. The tip of the thrombus aspiration catheter was broken and retained in the guide wire at the level of the proximal right coronary artery. The broken tip of the thrombus aspiration catheter was successfully retrieved percutaneously. 18 Dec, 2025 https://www.clinsurggroup.us/articles/OJT-9-151.php Introduction: Unresolved childhood traumas, throughout the human developmental stage, are capable of negatively affecting an individual’s psychophysical growth, promoting the onset of psychopathological conditions. In the literature, the intrapsychic processes capable of explaining this phenomenon are not yet known, and the specific consequences are not known with certainty. Method: The sample is composed of 44 Italian participants (16 males; 28 females), aged between 8 and 17 years (M: 12.9; SD: 3.1). By means of clinical interview and administration of the “Test of Separation Anxiety” (SAT), the “Perrotta Integrative Clinical Interviews”, version C-3 (PICI-C-3) and the “Perrotta Human Emotions Questionnaire” (PHE-Q), pediatric patients included in the population sample were investigated. Results: The data obtained from the research statistically showed significant differences (p < 0.001) between the clinical group and the control group, correlating pathological attachment style with a specific dysfunctional personality profile (p < 0.001), in the pediatric population studied. Conclusions: Unresolved childhood trauma is a predisposing factor for the onset of a psychopathological disorder, capable of impacting both functioning and personality structure; however, other factors have also been identified that, if present facilitate or exacerbate the morbid condition, such as the duration of exposure to the trauma, the repetitiveness of the negative effects of the trauma, the depth of the suffering experienced, possible behavioral reinforcers, other traumatizing causes, such as psychophysical violence (with or without sexual intent), genetic and familial predisposition to certain psychopathologies, extreme economic poverty, adverse socio-environmental and cultural context, and difficulty of integration. Early psychotherapeutic intervention can promote functional recovery. Key points: Unresolved childhood traumas are factors that predispose the onset of psychopathologies, but require other contributing causes to exert their dysfunctional power. Unresolved childhood traumas influence neuropsychological development from their onset. Unresolved childhood trauma has a greater negative impact, regardless of age, if it is amplified or maintained by other predisposing or facilitating factors, such as education received, personal and family lifestyle, social environment, and genetic predisposition. Sexual gender (male/female) does not play an important role in unprocessed childhood trauma, except to the extent of the sexual sphere, with a marked prevalence in the female population. 25 Nov, 2025 https://www.clinsurggroup.us/articles/OJT-9-150.php Introduction: The Focused Assessment with Sonography in Trauma (FAST) ultrasound exam is a critical tool used by medical providers in deployed settings to identify life-threating injuries and inform triage decisions. Its application to pediatric patients, however, remains underexplored and faces obstacles in austere, combat environments. Diagnostic inaccuracies using FAST in this context may result in unnecessary evacuations or missed injuries, straining battlefield resources and operational priorities. Case presentation: A six-month old female presented to a military treatment facility Emergency Department after a blunt trauma injury and received a FAST exam that was interpreted as positive for intraperitoneal free fluid. Her AST was mildly elevated at 67. Subsequent CT scan of the abdomen was negative for intrabdominal injury. Discussion: Pediatric FAST exams present unique questions which have not been considered adequately in the military medical literature. Although the FAST exam is not intended to be used in isolation, deployed medical providers have limited access to ancillary testing that could otherwise inform interpretation of a pediatric FAST exam. The relative rarity of pediatric trauma in the deployed environment heightens the risk of false positives and negatives. As demonstrated by the case presentation, even with ancillary testing and an experienced operator, the FAST exam in pediatric patients can yield false positives that could strain scarce resources in austere settings. Conclusion: With respect to the FAST exam in pediatric trauma patients, an urgent need exists for additional research, robust training, and a JTS CPG. 11 Jun, 2025 https://www.clinsurggroup.us/articles/OJT-9-149.php Introduction: In literature, the concept of egoism is associated with the psychic ego instance under hypertrophic conditions; however, there are currently no psychometric instruments capable of distinguishing the functional form (self-love) from its dysfunctional variants (infantilism, egocentrism, and narcissism). Aim: A validation study was conducted to assess whether the proposed psychometric instrument can reliably and validly investigate the efficiency of the ego psychic instance in relation to the hypotheses of hegonic hypertrophy. Materials and methods: A new psychometric instrument was developed for administration to a selected clinical population (144 males/females, aged 16-70 years, M: 40.2, SD: 16.4) and was compared with a previously used instrument (Narcissistic Personality Inventory, NPI). This comparison aimed to investigate the efficacy of the ego psychic instance, clinically assess the level of subjective egoism, and ultimately validate the new instrument. A control group with similar characteristics was selected. Results: Statistical analysis revealed that the psychometric test possesses a well-defined and stable construct, with the variables accurately represented and positively correlated with another already validated construct. Conclusions: The Perrotta Ego Hypertrophy Investigation Questionnaire, first edition (PEHI-Q), is a valid, efficient, and stable psychometric tool for examining the clinical aspects of ego hypertrophy. 21 Jan, 2025 https://www.clinsurggroup.us/articles/OJT-9-148.php The COVID-19 outbreak has led to unprecedented hazards to health and mental health globally at the beginning of 2020. These issues are being exacerbated by safety concerns and disruptions of daily routines especially for people in vulnerable groups, including international students in Canada, who experience a variety of stress and challenges in a new country. Additional acculturation stress stems from language barriers and cultural conflicts that can impact well-being and life satisfaction. The current study uniquely examined how anti-mattering and fears of not matter relate to acculturative stress, discrimination and stigma, and perceived stress of international students during the COVID-19 pandemic. Anti-mattering, fear of not mattering, acculturation stress, adaptability, social support, loneliness, and well-being were examined among 186 international students. As expected, anti-mattering and fear of not mattering were associated significantly with higher acculturation stress, perceived discrimination and stigma, perceived stress, and loneliness. They were also associated with lower adaptability, lower life satisfaction, and lower psychological well-being. Regression analyses showed anti-mattering and fear of not mattering predicted well-being. Results indicated that acculturation stress fully mediated the link between anti-mattering/fear of not mattering and well-being; Acculturation stress and social support fully mediated the effect of the fear of not mattering on life satisfaction. Adaptability significantly fully mediated the effect of anti-mattering on well-being. Our empirical findings are discussed in terms of the need for prevention efforts focused on enhancing mattering, limiting anti-mattering and associated fears, reducing social loneliness, and acculturation stress, and increasing social support and adaptability that contribute to feeling mattering and life satisfaction and psychological well-being. Our discussion focuses on practical suggestions that can help and facilitate the well-being of international students, especially during inordinately challenging times. 13 Dec, 2024 https://www.clinsurggroup.us/articles/OJT-8-147.php Background: The global COVID-19 pandemic has had extraordinary adverse effects, negatively impacting people’s physical health, mental health, and well-being. Measures such as quarantine, lockdown, and social distancing have exacerbated social isolation, loneliness, and mental health challenges. International students, as a particularly vulnerable population, confronted numerous challenges, including a lack of social support and networks. They required considerable adaptability to cope with the changes and uncertainties brought about by the pandemic. This study explored the effects of loneliness, and social support on the adaptability of international students in Canada during the pandemic. Specifically, it aimed to: a) Examine the relationships among loneliness, social support, and adaptability. b) Investigate the potential moderating effect of social support on the relationship between feelings of loneliness and adaptability. Methods: We recruited 186 international students attending universities in Canada to complete the informed consent and an online survey during the pandemic COVID-19. Participants took approximately 40 minutes; a $10 Amazon gift card was offered to the participants as an appreciation. Participants were measured on the UCLA Loneliness Scale, Perceived Social Support Scale, Adaptability Scale, and demographic questions. The data analysis was conducted in IBM SPSS 26. Results: During the pandemic COVID-19, international students in Canada demonstrated that better adaptability was significantly associated with lower levels of loneliness and greater social support. Feelings of loneliness were found to negatively impact predicted adaptability; however, the effect was fully moderated by the presence of social support. Additionally, the findings highlighted gender differences in how international students adapted to the challenges of the pandemic. Discussion and conclusion: Our discussion focuses on practical suggestions that can help international students enhance their adaptability and build stronger social support networks, ultimately reducing feelings of loneliness while studying abroad in Canada. Our conclusions emphasize the importance of enhancing adaptability among international university students to reduce feelings of loneliness during the pandemic COVID-19 in Canada. We also recommend prioritizing social support as a protective factor, which plays a crucial role in mediating the effects of loneliness on adaptability. 15 Oct, 2024 https://www.clinsurggroup.us/articles/OJT-8-146.php Introduction: Behavior is the consequence of cognitive processes that originate from multifactorial products, such as genetic predisposition, education received, and experience gained from the family and social context of reference. The deficiency or defect of one or more of these factors could cause psychopathological shaping in the individual that can foster or nurture deviant or antisocial behavior. It is necessary to investigate what are the main factors underlying the criminal phenomenon. Materials and methods: The literature up to August 2024 was reviewed and 40 articles were included in the research. The survey was conducted through the administration of an experimental Questionnaire-type sociological survey (QA2CPICB). Results: In this pilot study, a population of 49 individuals (42 males and 7 females) most with criminal records and currently addicted to narcotic substances / drugs / alcohol, aged between 24 and 57 years (M: 39.7; SD: 9.1), residents or permanent residents of the “Emmanuel” Communities of the Apulia Region (Italy), were selected. The variable of age is negatively correlated with the areas investigated by the QA2CPICB (as age increases, the impact of the factors investigated decreases). Conclusion: Variables that can describe lived life influences (such as traumatic childhood events, critical family and work issues, economic poverty in adulthood, and lack of stable and lasting affective-emotional support), psychiatric disorders, and social-environmental influences (such as degraded, poor, and/or criminal family and social environment) are negatively correlated with the age variable and serve as positive reinforcers for maintaining the pathological state of drug addiction and engaging in deviant or criminal conduct to procure the necessary economic liquidity. Early intervention, reeducation and economic-work support can act as a deterrent and negative reinforcer on drug addiction, promoting patient recovery and limiting further legally relevant behavior in the justice system. Key points 1. The social-environmental factor plays a central role in maintaining criminal conduct. 2. Criminal conduct is the prerequisite for nurturing the substance-dependence state of drug addicts. 3. Early intervention, reeducation and economic-work support can act as a deterrent and negative reinforcer on drug addiction, promoting patient recovery and limiting further legally relevant behavior in the justice system. 28 Mar, 2024 https://www.clinsurggroup.us/articles/OJT-8-145.php Introduction: The tibia shaft is a common site for bone fractures and open fractures. Tibia shaft fracture is mostly caused by high-energy trauma such as a fall from a height or a road traffic accident. The objective of this study was to evaluate the treatment outcome of tibia shaft fracture managed by close reduction and internal fixation with interlocking Intramedullary Nails (IMN) and to determine factors that are associated with tibia fracture infection. Methods: This retrospective study was conducted at the Emergency Trauma Hospital, Freetown, Sierra Leone. We analyzed the medical records of a mixed cohort of patients who were treated for, tibia shaft fracture by closed reduction and internal fixation with interlocking intramedullary nails for the period January 2020 to January 2022; with at least 15 months of follow-up. We later used both bivariate and multivariate logistic regressions to determine the factors that are associated with wound infection post-internal fixation. Results: A total of Ninety (n = 90) patients’ medical records were reviewed of which 79 were included for analysis. The median age was 30 years (Inter Quartile Range: 16-67 years). The average hospital stay was 20 days (Inter Quartile Range: 6-156 days). The mean fracture nailing time was 11 days. Infection and non-union rates were at 18.99% and 3.8% respectively. Type of tibia shaft fracture (AOR = 25.51, 95% CI = 2.06-422.75,) and characteristics of wound (AOR = 29.51, 95% CI = 2.06-422.75) were significantly associated with wound infection. The treatment outcome categorization of IMN was successful in 88.61% of the patients. Conclusion: This study concludes that the type of tibia shaft fracture and characteristics of the wound are major predictors of wound infection. The findings of this study suggest that IMN fixation of closed and Gustilo type 1 Tibia shaft fracture led to successful healing in the majority of the cases with a low non-union rate. 12 Feb, 2024 https://www.clinsurggroup.us/articles/OJT-8-144.php South Sudan, the newest African nation where firearms are owned almost by all men has always been experiencing waves of conflict since independence. Egypt which tried to colonize the country in the 1870s divided it into regions with Equatoria where the country’s capital city is located has always been a combat zone. Since then several firearms have continued to be used by both soldiers and the civil populace. Anti-personnel landmines and items of explosive ordnance that were either planted/left before or during these conflicts have caused many injuries to the country’s population. Many of these affected individuals have potentially lost their limbs. Nonetheless, an estimated 30% of amputees to whom the International Committee of the Red Cross has been delivering prosthetic limbs since 2008 were said to be landmine patients. Cattle raids alongside inter-communal fighting are quite common in South Sudan’s States and Central Equatoria State where Juba belongs. Road traffic accidents, particularly in the streets of Juba City where speeding is not well controlled by the concerned authority, are equally common. These and many others have led to limb amputations. Marriages and relationships are perhaps terminated the affected families experience hunger since a man is considered to be the main breadwinner. The World Health Organization has estimated the number of people living with limb loss in South Sudan to be 0.714% of the country’s 12 million population as per the 2012 report. Though traumatic injuries are thought to be topping the table, non-traumatic injuries are also on the rise. The United Nations Mine Action Service (UNMAS) has removed and destroyed nearly 40 thousand anti-personnel landmines and more than 1 million items of explosive ordinance in the Country, according to their report. What is the leading cause of amputation? Which sex or age group is the most affected by limb loss in South Sudan? What effects does limb loss inflict upon the life of an individual and the family? These were the steering wheels of this research. 08 Sep, 2023 https://www.clinsurggroup.us/articles/OJT-7-143.php Background: The first version of the Perrotta Human Emotions Model (PHEM) responded to the need for better structuring, in a functional framework, of emotions and sentiments, giving the proper role to anxiety, according to a neurobiological perspective, in a strategic scheme, but needs structural and functional corrections. Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001, as is the case when testing clinical utility by assessing it using MMPI-2-RF and PICI-2. Conclusion: This research confirms the clinical usefulness of administering the PHEM-2, compared with the previous version, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach. 14 Aug, 2023 https://www.clinsurggroup.us/articles/OJT-7-142.php Social work is strongly presented to support and decrease the suffering of people living in a crisis. The call to intervene professionally in such cases is highly demanded by government institutions, non-governmental organizations, international organizations, and United Nations agencies, the main umbrella that enfolded practitioner social workers in Lebanon. Although Lebanon has experienced successive crises for more than forty years, there is no national strategy for social work or for intervention during crises that must be developed by the Ministry of Social Affairs in collaboration with relevant institutions such as academia. However, considering that the Lebanese universities that graduate social workers are the most important source for developing that strategy based on evidence-based research, unfortunately, they did not do any action. The purpose of this article is to describe how these universities are preparing students and developing their capacities to deal with the crisis consequences. The focus of this article is the presence of the Crisis Intervention (CI) course in the curricula of universities. Data were collected from all Lebanese universities’ websites and catalogs with undergraduate-level social work majors (N = 6). The data were issued from reviewing the curricula of the six universities that covered the N = 290 course. Data shows that the CI course does not enclose three out of six published curricula as well and results indicate a modest appearance of the crisis and its relevant courses. Accordingly, at the end of the research, a syllabus of the crisis intervention course is proposed and will be shared with the six Lebanese concerned Universities. 12 Aug, 2023 https://www.clinsurggroup.us/articles/OJT-7-141.php The purpose was to investigate if a whiplash trauma may cause an increased concentration of the Neurofilament Light (NFL) protein, and if so; is this related to the injury severity and the radiological findings? Adult car occupants, with neck problems after rear-end collisions, were investigated in a study on Whiplash-Associated Disorders (WAD) in 1997-2001. The study protocol included a neurological examination, plain radiography and MRT of the cervical spine, and a lumbar puncture for Cerebrospinal Fluid (CSF) within six weeks after the accident. Similar CSF samples were also taken three and twelve months later. All CSF samples were analyzed for NFL. Of 52 subjects who entered the study, 43 completed it. The WAD grade was I in two of the 43 cases, II in 13, and III in 28. No one had radiological signs, indicating injuries to the cervical spine or spinal cord. Six subjects showed an increased NFL concentration at the primary examination. This was judged to be caused by whiplash trauma in three of them (7%). There was no relation between an increased NFL concentration and the number of pathological changes on plain radiographs or MRT. Neither was there a relation between the NFL concentration and the WAD grade. An increased NFL concentration can be found in some WAD patients. It might be difficult to relate such an increase to clinical or radiological findings. Further studies should investigate NFL as a marker for injuries to the central nervous system in whiplash trauma, including minimal traumatic brain injuries. 23 Jun, 2023 https://www.clinsurggroup.us/articles/OJT-7-140.php The objective of the article is to familiarize clinicians with duodenal injury and to recognize timely intervention to prevent morbidity and mortality associated with such injury. Although uncommon, duodenal injury challenges a clinician’s ability to diagnose and treat it in a timely fashion to prevent any associated mortality. The retroperitoneal anatomy makes duodenal injury difficult to diagnose. However, a high degree of suspicion based on the mechanism of injury and appropriate, timely diagnostic study leads to the correct identification of injury to the duodenum. The specific treatment depends on the type of injury that is detected. In conclusion, early recognition, and timely intervention of duodenal injury leads to a successful outcome. 23 Apr, 2022 https://www.clinsurggroup.us/articles/OJT-6-139.php Introduction: Diencephalic storm is characterized by extreme episodic catecholamine release in the presence of a stressor and it is usually refractory to standard antihypertensives. The treatment of choice during the crisis is propofol and the best preventative measure is to remove the stressor (i.e. ventilator). Case presentation: A 32-year-old male sustained 2nd and 3rd degree burn to 25 percent of the body surface area that included a severe inhalation component. The patient was admitted to the Burn Intensive Care Unit at the Arnold Luterman Regional Burn Center in Mobile, AL. The patient had frequent episodes (3-5 per day) of severe agitation that were accompanied by extreme tachycardia of > 200 beats per minute and hypertension (280/140). The inciting event was often endotracheal suctioning, but less noxious stimulation also resulted in similar episodes. During these episodes, the patient had significantly elevated catecholamine levels that improved after extubation. The patient’s symptoms were refractor to standard antihypertensives but immediately resolved when given propofol. Further episodes of the diencephalic storm were treated successfully with propofol. Once the patient was removed from mechanical ventilation, there were no further episodes. Conclusion: Diencephalic Storm may be difficult to diagnose due to a lack of familiarity with this rare entity. Any patient with severe agitation combined with the effects of episodic large catecholamine surges should be considered to have Diencephalic Storm. The standard immediate treatment is propofol due to the lack of responsiveness of standard antihypertensives and the removal of the stressor. 21 Oct, 2021 https://www.clinsurggroup.us/articles/OJT-5-138.php The spleen is an organ commonly injured in abdominal trauma of the upper left quadrant and until just under two decades the first choice was always splenectomy; however, based on new research and clinical experience, there is a tendency to preserve the spleen as much as possible, precisely because of its immune function and risk of infection. On the basis of the trauma and of the patient’s anamnesis, after an objective examination, the primary ABCDE evaluation, the Eco-FAST, and if necessary also the CT scan (with contrast), it is possible to choose between surgical (OM) and non-surgical (NOM) management: in the first hypothesis are included total or partial splenectomy surgery, raffia, direct hemostasis through drugs or devices with hemostatic-adhesive action, and laparoscopy; in the second hypothesis are included treatments such as controlled nutrition, rest, anticoagulant drug therapy (and antibiotic, if necessary), and angioembolization (exclusive or accessory to a NOM). In particular, in the last few years, a dual interpretation has emerged on the findings necessary to favour splenectomy (total or partial) over angioembolization. From the best clinical practice emerges therefore the answer to the question at hand, namely that the patient is a candidate for angioembolization if 1) is hemodynamically stable (with systolic blood pressure > 90 mmHg, heart rate < 100 bpm, and transfusion of < 3 units of blood in 24 hours) or stabilizable (positive response to rapid infusion of 1000-2000 cc of crystalloids-Ringer Lactate-with restoration of blood pressure and heart rate values in the range of hemodynamic stability); 3) there is no open trauma to the abdomen or evidence of vasoconstriction (cold, sweaty skin, decreased capillary refill) or obvious intestinal lesions or perforative peritonitis or high-grade lesions to the spleen or peritoneal irritation or signs of exsanguination or contrast blush or effusion (exceeding 300ml) detected by Eco-FAST. This preference is optimal concerning both the risks of postoperative infection and immunological risks; finally, age and head trauma, compared to the past, seem to be no longer discriminating conditions to favour splenectomy regardless. Splenic immune function is thought to be preserved after embolization, with no guidelines for prophylactic vaccination against encapsulated bacteria. Other clinical signs finally, however, might argue for discontinuation of NOM treatment in favour of a surgical approach: 1) need to transfuse more than 3 units of blood or simply the need for transfusion in 24 hours to maintain a maximum systolic blood pressure greater than 90 mmHg, correct anaemia less than 9 g/100 ml, or a hematocrit less than 30%; 2) persistence of paralytic ileus or gastric distension beyond 48 hours (despite a nasogastric aspiration); 3) increased hemoperitoneum (on ultrasound or CT); 4) aggravation of the lesion evidenced by ultrasound and/or CT (so-called “expansive” lesions); and 5) subsequent appearance of signs of peritoneal irritation. A complete understanding of post-embolization immune changes remains an area in need of further investigation, as do the psychological and mental health profiles of the surgical patient. 07 Oct, 2021 https://www.clinsurggroup.us/articles/OJT-5-137.php Purpose: This research addresses the topic of anxiety, phobic and obsessive disorders. In this research, the theme is addressed to the psychopathological investigation of personalities, according to the PICI-2TA model (Perrotta Integrative Clinical Interviews, version 2-TA), the PAD-Q (Perrotta Affective Dependency Questionnaire), the PSM (Perrotta Sexual Matrix), the PDM-Q (Perrotta Defence Mechanisms Questionnaire) and the PHEM model (Perrotta Human Emotions Model), in order to design a direct and functional psychotherapeutic protocol to manage the psychopathological process in the shortest time possible, according to the principles of efficiency, effectiveness and economy, trying to reduce the symptomatology until the total regression by the fifth-tenth session. Methods: Clinical interview and administration of the PICI-2, the PAD-Q, the PSM, and the PDM-Q. Results: In the male group, aged 18-36 years, there were 8 people, of whom 6 (75%) reacted to the total resolution of the neurotic symptomatology described between the fifth and ninth sessions, while only 2 (25%) said they felt their neurotic symptoms had subsided. In the male group, aged 37-54 years, there are 5 people, of whom 4 (80%) reacted to the total resolution of neurotic symptomatology described between the fifth and ninth sessions. In the male group, aged 55-72 years, there were 6 people, of whom 4 (66.6%) reacted to the total resolution of neurotic symptoms described between the ninth and tenth sessions. In the female group, aged 18-36 years, there were 22 people, of whom 18 (82%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. In the female group, aged 37-54 years, there were 13 people, of whom 9 (69.2%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth session. In the female group, aged 55-72 years, there were 11 people, of whom 8 (72.7%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. Conclusions: The research showed that the PPP-DNA protocol, for neurotic disorders, was effective in the total population sample for 74.36%, for the fractionated male population sample for 73.86% and for the fractionated female population sample for 74.86%, with resistance to change identified in adverse conditions of family, environmental, socio-cultural and temporal type (of duration of neurotic symptomatology), however able to promote an attenuation of the symptomatology suffered by at least 50%. 14 Sep, 2021 https://www.clinsurggroup.us/articles/OJT-5-136.php The current case is one of the rare clinical presentations of the brachial artery pseudo aneurysm presentation in children Pseudo-aneurism is one of the late complications of a missed or untreated arterial injury. The diagnosis is suggested in the presence of clinical signs such as: an expending, ill-defined mass with or without pulsation; bruit, pain, paresthesia, or paralysis due to nerve compression. Although plain X-Rays may show a nonspecific soft tissue mass, arteriography is essential in defining differentiating pseudo aneurisms from other soft masses. We report a case of a 10years old boy with a history of a stab injury in a well vascularized left cubital fossa region. The physical examination revealed a soft tissue mass with eroded skin. Ultrasound and MRI findings were respectively of an infected soft tissue mass and probable malignant soft tissue mass. Open biopsy was planned but surgical finding revealed a pseudo aneurism of the left brachial artery before its bifurcation. Brachial arterial lesion was repaired blood flow reestablished with clinical improvement. 29 Jul, 2021 https://www.clinsurggroup.us/articles/OJT-5-135.php Post-traumatic stress after abuse early in life, may be forgotten until late in life. Dissociative actions may be observed. An example of this is demonstrated in a case report from a resident psychiatric facility in Northern Norway. Under Norwegian Law, acts under dissociation is not regarded as being not fit for standing trial, but may be deemed a partial excuse. In the present case a sentence of 5 months was the result of court proceedings where dissociation was duly taken into account. 06 May, 2021 https://www.clinsurggroup.us/articles/OJT-5-134.php We react to serious mishaps, life altering setbacks, disasters, abuse, and death by going through the phases of grieving. Traumas are the complex outcomes of psychodynamic and biochemical processes. But the particulars of traumas depend heavily on the interaction between the victim and his social milieu. It would seem that while the victim progresses from denial to helplessness, rage, depression and thence to acceptance of the traumatizing events - society demonstrates a diametrically opposed progression. This incompatibility, this mismatch of psychological phases is what leads to the formation and crystallization of trauma. 29 Dec, 2020 https://www.clinsurggroup.us/articles/OJT-4-133.php This report looks into the current situation with regard to administering of Covid-19 vaccines within the United States and makes suggestions on how to aid the decision-makers’ process. The study method is based on a review of existing data on Covid-19 vaccines and their effectiveness in eliminating the possibility of getting infected by the virus. The procedure utilizes the corresponding (incomplete) data that could theoretically be used in other decision-making methods. The review discovered that the information provided by the vaccine manufacturers is somewhat vague. The process entails predicting the future trend in Covid-19 mutation and the effectiveness of the existing vaccines in controlling the disease. The study interviewed 1200 vaccinated patients to give an opinion based on the patients. 06 Oct, 2020 https://www.clinsurggroup.us/articles/OJT-4-132.php Diagnosis and treatment for traumatic dental injuries are very complex due to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and permanent dentitions. When further considering that fracture and luxation injuries are often combined, and can involve either dentitions, a great number of trauma scenarios may result [1]. Classifications, epidemiological, clinical and radiographic studies are considered very important to evaluate the particular case in each patient in order to correctly plan and conduct the treatments of these injuries. Therefore, even though oral-facial trauma has been extensively investigated, in vivo clinical essays are frequently needed to understand and improve the healing processes after trauma and to determine the best treatment in each case [2,3]. 18 Aug, 2020 https://www.clinsurggroup.us/articles/OJT-4-131.php Background: Trauma frequently occurs during pregnancy and can affect both mother and unborn child. It is essential to consider pregnancy in every female trauma patient of reproductive age. The management of a pregnant trauma patient is often considered to be complicated. Main body: Therefore, it is important to follow a clear management protocol of the appropriate approach of the pregnant trauma patient. Furthermore, some pregnancy-specific complications of trauma such as placental abruption, uterine rupture, premature uterine contractions and their management are presented. In pregnancy, the ABCDEF approach is used during the primary survey with the ‘F’ standing for fetus. Fetal vital signs are an important indicator of the maternal condition, and fetal outcome depends on maternal wellbeing. Concerning the secondary survey, a physical examination as well as indicated technical examinations should be performed with fetal monitoring being essential in a viable pregnancy. In case of non-reassuring findings, emergency caesarean section or laparotomy may be indicated. In case of cardiac arrest, advanced trauma life support management should be started and the aetiology of cardiac arrest should be sought using the BEAUCHOPS tool. Early airway protection with adequate oxygenation and ventilation as well as effective chest compressions with tilting of the mother or manual displacement of the uterus, are essential. Conclusion: A systematic approach (ABCDEF) of the traumatised pregnant patient is even more essential than in the non-pregnant patient. Saving the mother is crucial if you also want to save the unborn child. 21 Jul, 2020 https://www.clinsurggroup.us/articles/OJT-4-130.php We report on a 29-year-old male patient, who presented at our clinic with mild left ptosis and miosis and with plegia of the left upper limb too. The patient also complained with severe crushing sensation and a constant burning over the left hand. He was injured in motorcycle collisions. 29 Jun, 2020 https://www.clinsurggroup.us/articles/OJT-4-129.php Backgroud: Patients with Parkinson’s disease are at increased risk for falls and associated hip fractures as a result of tremor, rigidity, and postural instability. The available literature is limited and conflicting regarding the optimal surgical treatment and risk for postoperative complications and mortality in this unique patient population. This study question the effectiveness of mobility total hip arthroplasty in Parkinson’s disease patients with proximal femoral fractures. Patients and methods: Twelve patients (13 hips) with proximal femoral fracture (fracture neck of femur in 6 cases, unstable trochanteric fracture in 5 cases and failed fixation of trochanteric fracture in 2 case). Cemented dual mobility acetabular components were used in 9 patients and a cementless dual mobility acetabular components was used in 4 patient. Follow up reports on:postoperative complication rates, in-hospital mortality, length of hospital stay, discharge status, mortality rate, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living. The mean age 65 years and the mean follow-up 32 months. 12 Jun, 2020 https://www.clinsurggroup.us/articles/OJT-4-128.php Introduction: Trauma is an important worldwide public-health problem. This study aims to evaluate the median trauma resuscitation time (TRT) at Sultan Qaboos University Hospital (SQUH), Oman, and to investigate the reasons for delay in trauma resuscitation. Documenting TRT can be utilized to assess areas of improvement for trauma team performance, ensuring a high-quality resuscitation management that improves trauma patients’ survivability. 08 Jun, 2020 https://www.clinsurggroup.us/articles/OJT-4-127.php Transepiphyseal Fracture of Distal Humerus ( TFDH ) or epiphysiolysis of distal humerus is a rare injury seen in children younger than three years of age [1]. It is the least commonest of all physeal injuries representing 3.9% of them in this age group [2]. The reported incidence of this injury is 1:35000 births [3]. The diagnosis of this condition is very challenging and in particular differentiating it from elbow dislocation is very difficult. Plain radiographs are not decisive since ossification centers around elbow are not ossified during this age group. 28 May, 2020 https://www.clinsurggroup.us/articles/OJT-4-126.php Forensic entomology is based on the use of scavenging insects to estimate the time of death in the course of judicial inquiries and allows in some cases specify the circumstances of death. This technique is based on solid scientific basis and is now commonly used as part of criminal cases. 22 May, 2020 https://www.clinsurggroup.us/articles/OJT-4-125.php Attachment is defined as a dynamic system of attitudes and behaviours that contribute to the formation of a specific bond between two people; 28 Mar, 2020 https://www.clinsurggroup.us/articles/OJT-4-124.php The rising trend of obesity in the United States has been a growing concern within the healthcare system for decades. Since the early 1960s, the prevalence of obesity has more than doubled among U.S. adults, and one out of every three Americans is now considered obese according to the National Health and Nutrition Examination Survey [1,2]. Significant medical comorbidities have been associated with obesity and increased Body Mass Index (BMI); these include hypertension, dyslipidemia, coronary artery disease, stroke, sleep apnea, type II diabetes mellitus and certain types of cancer. 20 Feb, 2020 https://www.clinsurggroup.us/articles/OJT-4-123.php Introduction: As very few African publications are found in the literature concerning Brodie’s abscesses, we report a rare case of the association of a Brodie’s abscess with soft tissue swelling in a sportsman in Abidjan (Ivory Coast). Report case: A 30-year-old patient presented knee pain associated with swelling of the distal third of the thigh as a result of a sports trauma. The diagnosis of a Brodie’s abscess was made. Surgical treatment combined with antibiotic therapy was performed. The evolution was favourable. 20 Sep, 2019 https://www.clinsurggroup.us/articles/OJT-3-122.php Ankle Fractures in the paediatric population are among the most common physeal injuries. Trauma around the ankle often results in distal tibial metaphyseal fractures in the very young child, medial and lateral malleolus fractures in middle childhood (McFarland fractures) and transitional fractures in adolescence (Tillaux and Triplane fractures). 22 Aug, 2019 https://www.clinsurggroup.us/articles/OJT-3-121.php Femoral head translation leads to the cam deformity development. It is formed on the femoral head-neck junction. Cam deformity produces femoroacetabular impingement. There are no particular techniques for femoral head translation assessment. The offset index is the most regularly applied. It quantifi es the relation between the femoral head and neck junction. We introduce the original method to test the femoral head translation. 20 Jul, 2019 https://www.clinsurggroup.us/articles/OJT-3-120.php The aim of the study is to determine the importance of nerve block in rib fracture patients. Methods: During the period January 2017- December 2018 a retrospective study took place. Eighty four patients diagnosed already with rib fractures underwent nerve bock by thoracic surgery department at General Hospital of Nicaea-Piraeus, Greece. 11 Jul, 2019 https://www.clinsurggroup.us/articles/OJT-3-119.php Damage control surgery concept (DCS) consists of performing a staged surgery and allowing resuscitation in severe trauma patients who require surgical management. Initially, the DCS has been described in severe liver trauma associated with coagulopathy. Over time, Due to the observed advantages, the DSC approach has become standard practice for abdominal trauma with the extent to extra-abdominal trauma and acute abdominal emergencies. 13 May, 2019 https://www.clinsurggroup.us/articles/OJT-3-118.php Patellar fractures are uncommon, accounting for only 2% of all fractures [1]. Sleeve fractures were first reported in 1978 by Houghton and Ackroyd and occur predominantly in children. This fracture results in the inferior sleeve of articular cartilage being avulsed along with the periosteum and retinaculum from the patella. Inconsistently the avulsed fragment can contain a small bony component. [2,3]. 08 Apr, 2019 https://www.clinsurggroup.us/articles/OJT-3-117.php Psychosis, dissociation or simple aggression may have similar clinical presentations. A case in a resident facility for trauma treatment is presented and discussed. Getting triggered by someone often happens in patients with dissociative disorders after childhood traumatization, rarely so in psychosis. Aggressive acts may also be seen without apparent connection to trauma. 29 Jan, 2018 https://www.clinsurggroup.us/articles/OJT-2-116.php Premature closure of the distal radius physis is rare and is usually associated with a fracture pattern that involves the physis. 04 Dec, 2017 https://www.clinsurggroup.us/articles/OJT-1-115.php Risk factors relating the surgical outcomes of lower leg traumatic compartment syndrome in Vietnam. 29 Nov, 2017 https://www.clinsurggroup.us/articles/OJT-1-114.php Fournier’s gangrene is a rapidly progressive and potentially fatal infective necrotizing fasciitis of the perineum, external genitalia and/or perianal regions. The most common etiology of the infection is bacterial; however, there have been published cases of Fournier’s gangrene caused by yeast in patients with severe immunosuppression. Cutaneous fungal infections are often opportunistic and typically occur in immunocompromised patients with diabetes and additional chronic conditions. 09 Nov, 2017 https://www.clinsurggroup.us/articles/OJT-1-113.php Objectives: 1) Study the clinical and radiographic characteristics of both bones forearm fractures in adults. 2) Evaluate the surgical outcomes of plate and screws fi xation for these fractures. 02 Aug, 2017 https://www.clinsurggroup.us/articles/OJT-1-112.php The Morel-Lavallée lesion is a closed, post-traumatic, soft tissue degloving injury. There is separation of the skin and subcutaneous tissue from the underlying fascia resulting in an effusion and creation of a perifascial space often containing lymph and necrotic fat. 14 Jun, 2017 https://www.clinsurggroup.us/articles/OJT-1-111.php Whiplash Associated Disorders (WAD) have caused frustrating problems since decades for people injured in various types of accidents. Certain circumstances and misunderstandings explain this anomaly. 19 May, 2017 https://www.clinsurggroup.us/articles/OJT-1-110.php This paper presents news concerning the transportation of the whole cross on the shoulders and the falling mode of the Turin Shroud (TS) Man on the ground that explains the detected traumas. These news base themselves on the hypothesis that the TS Man is Jesus of Nazareth. 11 Apr, 2017 https://www.clinsurggroup.us/articles/OJT-1-109.php Due to the lack of information, the pathogenesis of the death of Jesus of Nazareth is still widely debated. A univocal pathogenesis can be detected by the close comparison between what is reported in the Holy Bible (in particular the four Gospels and the prophetic passages of the Old Testament) and what can be observed on the Turin Shroud (TS). 21 Mar, 2017 https://www.clinsurggroup.us/articles/OJT-1-108.php Introduction: Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. Immediate surgical repair is the standard of care and is superior to nonoperative management due to excellent long term outcomes. 17 Mar, 2017 https://www.clinsurggroup.us/articles/OJT-1-107.php The article reports a clinical case illustrating favorable outcome of nonsurgical treatment of a polytraumazed patient with occult severe cerebral fat embolism. The peculiar characteristics of the perfusion CT are demonstrated. 17 Mar, 2017 https://www.clinsurggroup.us/articles/OJT-1-106.php Intracranial arachnoid cyst (IHAC) is considered as rare congenital lesions. Usually the arachnoid cyst remains asymptomatic and incidentally picked -up on routine cranial imaging. Mostly, the intracranial arachnoid cyst is located in the sylvan fi ssure, cerebello-pontine angle, or suprasellar region. 13 Mar, 2017 https://www.clinsurggroup.us/articles/OJT-1-105.php Introduction: Over the last few decades, non- operative management (NOM) has become increasingly popular, especially for low-grade (I-III) blunt renal injuries. The published evidence is unclear about the role of NOM for higher grades (IV and V). We took up this study to report our short and long-term outcomes following initial nonoperative management in patients sustaining a grade 5 renal injury secondary to blunt trauma. 06 Mar, 2017 https://www.clinsurggroup.us/articles/OJT-1-104.php Background: Clavicular shortening often occurs after midclavicular fractures and its impact on functional outcomes has thus far been evaluated solely by radiographic and surgeon-based measures, with divergent findings. 21 Jan, 2017 https://www.clinsurggroup.us/articles/OJT-1-103.php A maxillofacial fracture is a serious clinical problem because of its functional and aesthetic signifi cance. If these injuries are treated improperly may ultimately result in a patient’s low quality of life. Diagnosis and treatment of these fractures remain a challenge for oral and maxillofacial surgeons, demanding a high level of proficiency. 11 Jan, 2017 https://www.clinsurggroup.us/articles/OJT-1-102.php Lesions of the biliary duct following a blunt abdominal trauma occurs infrequently, and even more so when it occurs in the intrapancreatic biliary duct. With the increase of conservative treatment in blunt abdominal trauma, the diagnosis of this entity can be difficult and delayed. 03 Jan, 2017 https://www.clinsurggroup.us/articles/OJT-1-101.php Introduction: Salt water near-drowning events are not uncommon in coastal regions. The difference in tonicity between salt and fresh water in near-drowning events leads many to believe there should be differences in the approach to managing the patient. We present a case of near-drowning in salt water and a thorough review of the literature in managing these patients.