Background: Exposure of children and young people to potentially traumatic events is common. There is a need for increased access to early interventions following a potentially traumatic event.Objective: This review aimed to identify early psychotherapeutic interventions which attempted to decrease posttraumatic stress responses and/or reduce the risk of developing persistent posttraumatic stress disorder.Method: We included papers that outlined a psychotherapeutic intervention delivered to children and young people in the acute (within 1 month) and early-post-trauma period (2 to 6 months), following a potentially traumatic event. Four databases were searched, including PubMed, PsycINFO, Web of Science, and ASSIA.Results: Twenty-one papers met the inclusion criteria. The most frequent technique identified was psychoeducation, often combined with other techniques. Interventions were typically delivered by highly experienced clinical professionals. Two interventions were delivered either by lay counsellors or community facilitators. Most interventions were delivered within 1 month of exposure.Discussion: All interventions delivered beyond 1 month after the event showed significant reductions in posttraumatic stress symptoms, whereas those delivered within a month yielded mixed results. Conclusions: There remains a scarcity of evidence on early interventions following potentially traumatic events. We identified interventions delivered by community professionals with less clinical experience, which could inform how we increase access to support following potentially traumatic events.
Posttraumatic stress disorder (PTSD) is a common comorbid diagnosis in psychotic disorders. However, little is known about the effect of comorbid PTSD in youth at clinical high risk (CHR) for psychosis. The purpose of this study was to investigate group differences in symptom severity, risk for psychotic conversion and functioning among youth at CHR for psychosis with and without PTSD. This longitudinal study utilized data from N = 693 individuals who met criteria for CHR as part of the North American Prodrome Longitudinal Study 3 (NAPLS-3). Individuals who met criteria for PTSD were compared to those who did not meet criteria for PTSD on demographic, symptom and functional variables. Individuals diagnosed with PTSD (N = 54) reported more severe overall positive symptoms (p = 0.008), negative symptoms (p = 0.043) and general symptoms (p = 0.008) compared to those without the diagnosis (N = 639). These symptom differences were primarily accounted for by more grandiose symptoms (p = 0.026), decreased experience of emotions (p = 0.043), sleep disturbance (p = 0.043), dysphoric mood (p = 0.012) and impaired tolerance to stress (p = 0.008) in those with PTSD. In Cox proportional hazards models using the full sample with censoring at last follow-up, PTSD diagnosis was not associated with time to psychosis conversion. Exploratory analyses of trauma subtype within the PTSD group also did not identify any trauma category significantly associated with conversion risk. Timing of trauma exposure (early childhood, middle childhood, adolescence) was not significantly associated with conversion. Our findings suggest that a diagnosis of PTSD is associated with more severe overlapping symptoms in individuals meeting the criteria for CHR but not psychotic conversion. Our findings underscore the importance of recognizing and treating comorbid psychiatric conditions including PTSD in CHR populations as a means of reducing symptoms and improving outcomes.
Traumatic brain injury is a major cause of death and disability in children, and early identification of high-risk cases is critical for improving clinical outcomes. This study aimed to develop and validate a clinical prediction model to estimate the 30-day in-hospital mortality in pediatric patients with moderate-to-severe traumatic brain injury (msTBI). A retrospective analysis was conducted on 289 pediatric patients admitted with msTBI. Independent risk factors were identified using the least absolute shrinkage and selection operator regression and multivariable logistic regression analysis to construct a clinical nomogram. Model performance was assessed using ROC curves, bootstrap validation, and decision curve analysis. The median age of the cohort was 5.17 (IQR, 2.75-9.33) years. There were 101 females and 188 males. Four independent predictors were identified: Glasgow Coma Scale score, lactic acid, albumin, and trauma-induced coagulopathy. The model showed AUC of 0.898 (95% CI: 0.896, 0.899) and good agreement between predicted and observed outcomes. Hosmer-Lemeshow test yielded a non-significant P-value (P = 0.475), supporting good model calibration. Clinical decision analysis demonstrated that the threshold probability ranged from 0 to 0.95. This study developed a reliable clinical tool to predict 30-day in-hospital mortality in children with msTBI. It may support early risk stratification and assist clinicians in making informed treatment decisions.
We present a rare case of post-traumatic ascending aortic dissection along with a sternal fracture. The patient underwent a successful surgical procedure involving excision of the aorta affected by dissection, replacement of the ascending aorta, and repair of the sternal fracture. Although traumatic injuries to the aorta are considered a common cause of death, reports on successful surgery for ascending aortic (Stanford type A) dissection with sternal fracture are scarce. To the best of our knowledge, this is the first such case reported from India, and only a few similar cases of traumatic ascending aortic dissection with solid viscus injuries of rib fractures have been reported from other countries. This case indicates that successful outcomes could be anticipated if diagnosed early and treated aggressively with replacement or repair of the ascending aorta on cardiopulmonary bypass (CPB).
Venous fat emboli are uncommon but important radiological findings in patients with long-bone fractures, and direct visualization on computed tomography (CT) is rarely reported. We report the case of a 34-year-old man with polytrauma, reported to be hemodynamically stable, admitted after a motorcycle road traffic accident. Initial radiography demonstrated a complete, displaced fracture of the proximal third of the left femoral shaft. Whole-body trauma CT revealed a fat-attenuation intravascular lesion within the distal left external iliac vein extending into the proximal left common femoral vein, with an attenuation value of approximately -81 Hounsfield units, consistent with a venous fat embolus. The lesion persisted in the same venous location across the available non-contrast, arterial-phase, and portal venous-phase images. Thoracic CT angiography showed no pulmonary arterial filling defect or acute pulmonary parenchymal abnormality on the available images. Abdominopelvic CT also demonstrated a superior polar splenic laceration measuring more than 3 cm in depth, associated with perisplenic hemoperitoneum, consistent with grade III splenic injury according to the American Association for the Surgery of Trauma classification. No definite active contrast extravasation was identified on the available arterial, portal venous, and delayed-phase images. Orthopedic fixation of the femoral fracture was subsequently performed; however, detailed follow-up data, including respiratory evolution, neurological status, laboratory data, splenic injury management, and discharge outcome, were not documented in the available medical record. This case highlights the importance of systematic venous assessment on whole-body trauma CT in patients with long-bone fractures and emphasizes the distinction between a CT-visible venous fat embolus and fat embolism syndrome, which remains a clinical diagnosis requiring appropriate clinical correlation.
Mild traumatic brain injuries (mTBI) affect millions of people worldwide every year as one of the most common clinical presentations in the emergency department. Diagnosis is mainly based on clinical criteria and computed tomography scans. The use of computed tomography causes high costs, long waiting times in daily clinical practice and radiation exposure. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) turned out to be potential biomarkers for the diagnosis of mTBI. This study retrospectively evaluates the possible use of these biomarkers combined as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department. Adult patients (n = 320) registered in the emergency department at a level 1 trauma emergency center in Germany (Cologne Merheim Medical Center/CMMC) between 11/2023 and 04/2024, with suspected mTBI, Glasgow Coma Scale (GCS) score 13-15 and within 12 h after trauma were considered. All evaluable patients underwent cranial CT (cCT) scans and blood tests for GFAP and UCH-L1 serum concentrations. Biomarkers GFAP and UCH-L1 were tested positive in 261 patients (82%) while CT detected intracranial injuries in only 29 patients (9%). Biomarkers combined had a sensitivity of 97% and a negative predictive value (NPV) of 98% in mTBI diagnosis with a negative CT scan. The biomarkers GFAP and UCH-L1 combined could play a potential clinical role in avoiding unnecessary cCT scans in emergency departments after mTBI, might reduce treatment times and reduce radiation exposure.
The optimal timing of surgical decompression for traumatic spinal cord injury (TSCI) remains uncertain. This study evaluated the association between ultra-early decompression and neurological outcomes, focusing on early post-injury time windows. Retrospective cohort study. Single tertiary trauma center. Eighty-two adult patients with TSCI who underwent surgical decompression between January 2022 and August 2024 were included. Patients with central cord syndrome, penetrating injury, incomplete imaging, follow-up <3 months, or unreliable neurological assessment were excluded. Surgical decompression at varying time thresholds (≤8, ≤10, ≤12, and ≤24 h after injury). Neurological improvement, defined as an increase of at least one AIS grade at ≥3 months. In AIS A patients, decompression within 8 h was associated with a higher rate of neurological improvement (87.5% vs 29.4%; OR 16.80, 95% CI 1.62-174.52). Multivariable analysis showed a substantial but non-significant effect for ≤8 h (aOR 4.99, 95% CI 0.83-29.95). A strong adjusted association was observed at ≤10 h (aOR 4.92, 95% CI 1.15-20.97). Shock was associated with lower odds of improvement. The most consistent associations were observed within the 8-12 h window. Earlier decompression may be associated with improved neurological outcomes after TSCI. The findings suggest that the therapeutic window for neurological recovery may lie within the first 8-12 h, although causal inference cannot be established.
To establish age- and time-specific recommendations for the treatment of traumatic anterior shoulder instability (TASI) and for return-to-sport (RTS) decision-making through a formal consensus process among European experts. The European Society of Sports Medicine, Knee Surgery and Arthroscopy-European Shoulder Associates (ESSKA-ESA) formal consensus methodology was followed. A steering group formulated 35 clinically relevant questions, 23 of which addressed treatment and RTS and are reported in Part 2. A structured literature review was conducted. Statements were drafted and graded based on the level of scientific support. Then, the rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Recommendations were tailored by age group (adolescents, young adults and older adults) and timing of instability (first-time vs. recurrent). The final global median (range) of the 23 questions was 9 (8-9). Eleven questions achieved strong agreement, 11 relative agreement and 1 uncertain agreement. The grades of recommendations were: A in 0 (0%) statements, B in 30 (35.3%) statements, C in 24 (28.2%) statements and D in 31 (36.5%) statements (each statement could have more than one grade of recommendation). Bone loss and soft tissue lesions were key factors in decision-making. The consensus emphasized individualized thresholds for surgical versus conservative management, highlighting the role of bone augmentation in subcritical (bone loss 10%-15%) (especially in bipolar bone loss) and critical defects (bone loss >20%), lesion-specific soft tissue repair and the limited role of immobilization. RTS criteria included pain-free full range of motion, shoulder stability, strength and sport-specific readiness, typically achieved between 4 and 6 months depending on the procedure and sport demands. This ESSKA-ESA European Formal Consensus delivers practical, evidence- and experience-based recommendations for treatment and RTS following TASI according to age- and time-specific (first time and recurrent) scenarios. By integrating recurrence status, bone loss, soft tissue injury and sport type, the consensus provides a clinically valuable framework for individualized decision-making. Level II.
Anatomical variations in the brachial plexus can significantly affect upper-extremity surgical procedures. This report highlights a rare case where both pectoralis muscles receive accessory innervation. The pectoralis major exhibited three additional branches stemming directly from the anterior divisions of the superior and middle trunks, effectively bypassing the lateral cord. The pectoralis minor likewise demonstrated variant innervation, receiving two additional branches. One was an unexpected confluence in which a branch destined for the pectoralis major coursed through and innervated the pectoralis minor, despite the pectoralis minor typically receiving its own independent branch. The other branch originated from the anterior division of the middle trunk. Furthermore, a variant ansa pectoralis was identified, originating from the anterior division of the middle trunk and medial cord, and giving rise to the medial and lateral pectoral nerves. This unique configuration may present clinical implications for surgeons, particularly during procedures involving the proximal upper limb and supraclavicular pectoral region. Identifying these variations can help minimize the risk of iatrogenic nerve injury and enhance surgical planning.
We present a case of a 60-year-old female patient who presented to a community hospital emergency department after a motor vehicle collision with car intrusion, with left eye proptosis, ecchymosis, decreased left-sided extraocular movement, and progressive eye pain. Clinical findings were consistent with orbital wall fracture and retrobulbar hematoma leading to orbital compartment syndrome (OCS). Lateral canthotomy was performed in the emergency department of an acute-care hospital without on-site ophthalmology prior to transfer to a tertiary care center. This case highlights the importance of recognizing OCS, which requires time-sensitive intervention to prevent permanent vision loss, and the ability of emergency physicians to perform the procedure in a suboptimal setting.
Inferior vena cava (IVC) thrombosis is a rare but serious complication. We report a case of delayed presentation of abdominal compartment syndrome (ACS) secondary to IVC thrombosis, which contributed to progressive multi-organ dysfunction syndrome. Increased intra-abdominal pressure further resulted in venous stasis and thrombus formation, exacerbating systemic deterioration. Despite supportive care and attempted interventions, the patient developed refractory organ failure and expired. This case underscores the critical importance of early diagnosis and timely management of ACS to prevent vascular complications and fatal outcomes.
Major surgery and traumatic injury are potent triggers of systemic inflammation. While appropriately regulated inflammation supports host defense and tissue repair, dysregulated and time-dependent inflammatory trajectories contribute to postoperative and post-traumatic complications, organ dysfunction, prolonged disability, and mortality. Translation of mechanistic insight into effective bedside strategies has been limited by marked inter-individual heterogeneity, rapid phase shifts in the inflammatory response, and the absence of operational workflows that measure inflammation with sufficient biological and temporal resolution to guide patient-specific decisions. This perspective introduces 'inflammatory stewardship' as a precision-medicine paradigm for proactive management of acute inflammation in perioperative and critical care settings. Inflammatory stewardship integrates two core components: inflammatory staging and biomarker-guided immunomodulation. Inflammatory staging uses serial, multidimensional monitoring to characterize trajectories and to determine whether a patient's current inflammatory status lies within an individualized target range. Monitoring may combine routinely available clinical parameters with more specific immune phenotyping, functional assays, and molecular signatures, provided that assays are standardized, clinically interpretable, and available within actionable turnaround times. Biomarker-guided immunomodulation then links off-target trajectories to patient-specific escalation or de-escalation strategies, supported by predefined safety criteria and interdisciplinary governance. This perspective outlines key implementation requirements and a research agenda to establish reference trajectories, validate actionable endotypes, and embed biomarkers into adaptive interventional study designs. Inflammatory stewardship offers a testable roadmap to operationalize personalized inflammation management after surgery and trauma, aiming to enable earlier detection of maladaptive trajectories and more effective, patient-tailored immunomodulatory care in intensive care.
Post-traumatic stress disorder (PTSD) screening and prediction tools are widely used in veteran and trauma-exposed populations, yet methodological practices show substantial gaps. Rigid threshold application, inconsistent calibration reporting and limited attention to sex-based performance differences, comorbid conditions including traumatic brain injury (TBI) and moral injury and cultural context may introduce inequities and reduce clinical utility. PTSD screening programmes miss cases in some groups while over-referring in others, yet lack practical guidance for addressing these disparities. We provide an implementation framework that operationalizes existing standards (TRIPOD-AI, PROBAST-AI) with concrete, PTSD-specific procedures for calibration assessment, sex-stratified analysis and comorbidity integration. We conducted a systematic scoping review of PTSD screening and prediction studies (2019-2024, n = 75 studies) and synthesized published meta-analytic evidence on TBI-PTSD associations as a worked exemplar of comorbidity integration. We developed a tiered implementation framework (Tier 1: minimum standards; Tier 2: recommended practices; Tier 3: excellence standards) addressing observed heterogeneity. Technical feasibility was demonstrated using synthetic data explicitly matching published PTSD parameters from landmark veteran studies. The scoping review of 75 studies (2019-2024) found that only three studies (4.0%) reported calibration metrics, and only 10.7% provided sex-disaggregated performance metrics. Current reporting practices inadequately address TBI-PTSD comorbidity heterogeneity, moral injury (0% of studies) and cultural adaptation. These findings document substantial methodological gaps and demonstrate framework recommendations target empirically observed heterogeneity. The framework organizes recommendations into three tiers based on feasibility and resource requirements. Tier 1 standards (achievable by all studies) include: precise population definition, pre-specified thresholds, calibration slope reporting, sex-disaggregated performance and missing data documentation. Tier 2 recommendations (feasible for most studies) include: bootstrap internal validation, formal sex-stratified calibration testing with specified interaction thresholds (|β3| > 0.10), decision curve analysis, comorbidity integration and multiple imputation (m ≥ 20). Tier 3 excellence standards (aspirational for well-resourced studies) include: rigorous multi-site external validation, annual calibration monitoring and cultural adaptation for refugee contexts. Synthetic data demonstration (n = 850, matching Bovin 2016 and Wortmann 2016 published parameters: PTSD prevalence = 33%, PCL-5 distributions, TBI prevalence = 35%) confirmed technical feasibility using standard statistical software. Bootstrap validation (500 iterations) yielded optimism-corrected AUC = 0.969 with negligible optimism. Sex-stratified analysis detected meaningful calibration differences (|Δ| = 0.14, exceeding threshold). Comorbidity analysis revealed prevalence stratification (40.4% vs. 30.6%) despite minimal discrimination improvement (ΔAUC = +0.003), clarifying comorbidity's dual role in prediction versus case-finding. Published meta-analyses demonstrate consistent TBI-PTSD associations (2.68× risk overall; 4.18× in military populations) alongside substantial prevalence heterogeneity (I2 = 96%) that current reporting practices inadequately address. Using TBI as a worked exemplar of comorbidity integration alongside sex-stratified validation, moral injury assessment and cultural adaptation, the tiered framework provides PTSD-specific operational guidance for implementing established methodological standards, designed for incremental adoption based on study resources. All Tier 2 components are implementable with standard methods and moderate sample sizes. Prospective validation studies are needed to assess whether framework implementation improves calibration stability, subgroup equity and clinical outcomes compared to standard practice.
To provide an overview of the evidence comparing the use of balanced crystalloids and normal saline in critically ill patients. A comprehensive literature search was conducted in PubMed®, Embase, and Cochrane databases through July 2024. Systematic reviews with meta-analyses comparing balanced crystalloids versus normal saline in critically ill patients were included. The methodological quality of the included reviews was assessed using the AMSTAR-2 tool. Fourteen systematic reviews published between 2018 and 2024 met the inclusion criteria. Key clinical outcomes evaluated included mortality, acute kidney injury, and initiation of renal replacement therapy. Patient subgroups analyzed encompassed sepsis, trauma, hypovolemia, traumatic brain injury, postoperative status (cardiac and non-cardiac), and elderly populations. The methodological quality assessment of reviews using AMSTAR-2 revealed that most reviews had critical weaknesses in one or more domains. Quality appraisal revealed that one review had no critical domain weaknesses, while 13 reviews exhibited limitations in these domains. Evidence synthesis indicated a small benefit of balanced crystalloids compared to normal saline, especially among patients with sepsis and those without traumatic brain injury. This overview of systematic reviews suggests a small clinical advantage of balanced crystalloids over normal saline in critically ill patients, particularly in subgroups such as those with sepsis.
ObjectivePediatric head trauma is common, but computed tomography exposes children to ionizing radiation. This systematic review and meta-analysis evaluated the diagnostic accuracy of point-of-care ultrasound for pediatric skull fractures and clarified its role as an adjunct to clinical assessment rather than a replacement for computed tomography when intracranial injury is suspected.MethodsWe conducted a systematic review and bivariate random-effects diagnostic test meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in the International Prospective Register of Systematic Reviews (Registration Number: CRD420251139217). PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 3 September 2025. Two reviewers independently screened studies, extracted 2 × 2 diagnostic data, and assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsNine studies conducted in emergency department settings met the inclusion criteria. Point-of-care ultrasound demonstrated a pooled sensitivity of 0.90 (95% confidence interval: 0.84-0.94), specificity of 0.98 (95% confidence interval: 0.94-0.99), and an area under the summary receiver operating characteristic curve of 0.96 (95% confidence interval: 0.94-0.97). The summary positive likelihood ratio was 41.73 (95% confidence interval: 15.85-109.87), and the negative likelihood ratio was 0.10 (95% confidence interval: 0.07-0.17). Deeks' funnel plot showed no evidence of small-study effects (P = 0.80).ConclusionsPoint-of-care ultrasound shows high diagnostic accuracy for detecting pediatric skull fractures and may support bedside risk stratification in selected children with low- or intermediate-risk mild head trauma. However, most isolated linear skull fractures are managed conservatively, and point-of-care ultrasound does not evaluate intracranial injury. Computed tomography decisions should therefore remain anchored in neurological status, injury mechanism, validated pediatric head injury decision rules, and clinician judgment.
We report two rare cases of intrahepatic splenosis in patients with distant histories of abdominal trauma and highlight the diagnostic challenges splenosis can pose for clinicians, radiologists, and pathologists. Pathologic and clinical data for the patients were obtained from our institutional and referral records. Patient 1 is a 44-year-old male with a history of heavy alcohol use who presented with chest pain. Imaging study revealed alcoholic steatosis and multiple liver lesions. Patient 2 is a 53-year-old female with a history of primary biliary cholangitis and chronic liver disease who was found to have multiple hepatic lesions during routine follow-up. Imaging studies in both cases raised concern for both benign and malignant processes. Biopsies demonstrated prominent congested thin-walled vascular structures, scant fibrous stroma, and background lymphocytic infiltrates. Immunohistochemistry (IHC) for ERG, CD31, and CD8 highlighted the endothelial cells of the vascular structures, phenotypically consistent with littoral cells of splenic sinuses. Further review of the clinical history revealed remote traumatic motor vehicle accidents resulting in splenectomy in both patients. After clinical, radiologic, and pathologic correlation, the diagnosis of splenosis was made in both cases. Our cases highlight the distinctive clinical history and characteristic histologic and immunophenotypic features essential for diagnosing splenosis.
Oral fiberoptic-guided intubation can be challenging in anesthetized patients due to loss of pharyngeal muscle tone, resulting in posterior displacement of the tongue, soft palate, and epiglottis. Maneuvers such as jaw thrust can improve patency, but their effectiveness may vary with patient position. Semi-sitting positioning has been shown to reduce upper airway collapsibility. This study compared airway clearance obtained by jaw thrust in the semi-sitting versus supine position during oral fiberoptic intubation. This prospective randomized comparative study included adult American Society of Anesthesiologists (ASA) I-II patients aged 18-60 years undergoing elective surgery with orotracheal intubation. Patients were randomized into two groups: semi-sitting at 25° with jaw thrust (Group SS) and supine with jaw thrust (Group S). Airway clearance at the soft palate level (primary outcome) and at the epiglottis, time to visualize the vocal cords and carina, attempts required for tube advancement, total intubation time, and post-extubation airway trauma were assessed. Statistical analysis used chi-square and Student's t-test, with p<0.05 considered significant. Sixty patients completed the study (30 per group). Airway clearance at the soft palate was significantly better in the semi-sitting group (p<0.001). Clearance at the epiglottis was comparable between groups (p=0.100). Time to visualize the vocal cords (12.35±6.68 vs. 15.99±5.37 s; p=0.024) and carina (19.92±7.10 vs. 25.05±7.03 s; p=0.007) was significantly shorter in the semi-sitting group. Tube advancement attempts, time for tube passage, total intubation time, and incidence of trauma or postoperative sore throat were similar across groups. No intubation failures or desaturation occurred. Jaw thrust in the 25° semi-sitting position provides superior airway clearance at the soft palate and allows faster visualization of the vocal cords and carina during oral fiberoptic intubation. Overall intubation time and tube advancement characteristics remain similar between positions. Semi-sitting positioning may therefore be a useful adjunct to improve pharyngeal patency and facilitate fiberoptic-guided intubation in anesthetized patients.
The personal recovery approach in mental health draws on people's own experiences to build care policies. Models of personal recovery constructed in recent decades have been based on studies in Anglo-European cultural settings. No study has been conducted in Martinique, where Creole culture is prevalent. Our work aimed to explore the recovery experiences of people with schizophrenia in Martinique. We carried out a qualitative study. Fifteen people participated in a face-to-face interview, with collection of sociodemographic data. Three themes emerged from the analysis: self-work; evolving illness role; and rebuilding identity. Our results described a recovery process in which strong importance is given to social norms, involving difficult adjustments among multiple therapeutic approaches and overcoming psychological trauma. Access to employment, housing, and financial autonomy was related to social recognition. These results suggested the value of different approaches to aid recovery, including: support from relatives, peers, and caregivers; valuing their experiential knowledge; support for psychological trauma; fighting against the stigmatization of schizophrenia in Martinique; social support for work and housing empowerment; and recognition of the complementarity of the biomedical, religious, and traditional health care sectors.
Angiomatous epulis, also known as vascular epulis or gingival pyogenic granuloma, is a benign reactive gingival lesion characterized by marked capillary proliferation. It typically develops in response to chronic local irritation, trauma, inflammatory stimuli, or hormonal influences. Clinically, it presents as a rapidly growing erythematous to violaceous gingival mass with a marked tendency to bleed, which may mimic malignant gingival tumors and raise diagnostic concern. Although the diagnosis is primarily based on clinicopathological correlation, imaging plays an important complementary role. Radiological evaluation, particularly computed tomography (CT), is useful to assess lesion extent, confirm its superficial localization, and exclude aggressive features such as bone erosion or deep tissue invasion. Imaging also contributes to the differential diagnosis by helping distinguish angiomatous epulis from other gingival lesions, including peripheral giant cell granuloma, peripheral ossifying fibroma, vascular malformations, and malignant tumors. We report the case of a 15-year-old patient presenting with a rapidly progressive gingival mass evolving over two months. Periapical radiography demonstrated preserved alveolar bone architecture, while CT imaging confirmed a well-circumscribed soft-tissue lesion confined to the gingiva, without cortical bone destruction, periodontal ligament alteration, or extension to adjacent structures. Given the rapid growth and bleeding tendency, imaging was essential to exclude malignancy and guide management. Complete surgical excision was performed, and histopathological examination confirmed the diagnosis of angiomatous epulis. This case highlights the added value of imaging in the diagnostic workup of vascular gingival lesions, particularly in differentiating benign entities from malignant conditions and in supporting appropriate therapeutic decision-making.
Prior research has established several risk factors for poor neurobehavioral outcomes after traumatic brain injury (TBI) in Iraq/Afghanistan-era-Veterans. However, no studies have examined the impact of environmental exposures on neurobehavioral symptoms in this population. The purpose of this study was to examine the relationship between environmental exposures and neurobehavioral symptoms in post-9/11 Veterans with a probable history of TBI. Veterans Affairs (VA) Million Veteran Program (MVP). Participants included MVP-enrolled Veterans who completed the Veterans Health Administration's (VHA's) TBI Screening and Evaluation Program. Eligible participants were those who screened positive for TBI on the VHA Clinical Reminder Screen (N = 3370). Retrospective, cross-sectional design using secondary data analysis. Primary outcomes were 6 indices derived from the Neurobehavioral Symptom Inventory (NSI): total score (overall symptom severity), positive symptom total (symptom breadth), and 4 system clusters (vestibular, somatic/sensory, cognitive, and affective). Environmental exposures were self-reported by MVP surveys and included an exposure burden score and 7 individual exposure types: chemical or biological warfare agents; solvents/fuels; petroleum/combustion products; lead; other metals; pesticides; and open-air burn pits. The most frequently reported environmental exposures included petroleum combustion products (90.38%), burn pits (87.58%), and solvents/fuels (84.25%). Adjusted linear regression analyses, controlling for age, sex, race/ethnicity, and posttraumatic stress disorder status, showed significant positive associations between exposure burden and most neurobehavioral symptom outcomes (β = 0.13-1.08, all Ps < .001). In addition, there were several significant associations observed between each individual exposure variable and NSI outcomes, with the most consistent effects observed for other metals (β = 0.37-3.14, all Ps = <.001) and solvents/fuels (β = 0.88-2.95, all Ps = <.001). In post-9/11 Veterans with a probable history of TBI, environmental exposure burden and specific exposure types (particularly other metals and solvents/fuels) were associated with greater neurobehavioral symptom severity and breadth, suggesting environmental exposures as an additional, important contributor to chronic symptoms.