Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Diagnosis and management of colon cancer patients presenting in advanced stages of complications

Colorectal cancer is an important health problem with a significant impact on the individual and society. Malignancy (including colorectal cancer) is usually slightly symptomatic in its initial stages. This causes cancer to be discovered in some patients accidentally (either through screening tests in predisposed individuals or during routine investigations for other diseases), while in other patients the colorectal cancer is discovered in late stages, when the symptoms are much more intense due to complications. Unfortunately, such advanced cases of the disease have high rates of morbidity and mortality even with treatment. Current treatment methods are usually complex, interdisciplinary, causing significant suffering (physical, mental) to the individual, while the cost of treatment per patient seems to be extremely high. Until finding therapeutic methods that are effective and accessible to most patients with advanced colorectal cancer, several methods of prophylaxis and early diagnosis should be considered, to reduce as much as possible the devastating impact of this disease. The purpose of this review is to present literature data regarding the current methods of diagnosis and treatment of patients presenting to the doctor with colorectal cancer in advanced stages of complications

Ketorolac Use and Incidence of Postoperative Bleeding in an ERAS Colorectal Surgical Population: A Quality Analysis of Practice

Background Ketorolac is an effective analgesic adjunct and is currently used in Enhanced Recovery After Surgery (ERAS) protocols. However, investigation into its safety profile is warranted in specific surgical populations. This Quality Improvement (QI) study sought to examine the association of ketorolac to increased postoperative bleeding risk, increased postoperative renal impairment, and 30-day readmission within an ERAS protocol for colorectal surgery. Methods A retrospective review was conducted of 158 patients enrolled in an existing ERAS protocol for colorectal surgery with at least one dose of ketorolac administered in the perioperative period. Outcomes of postoperative bleeding, 30-day readmission, and preoperative/postoperative serum creatinine levels were assessed. Results There was no statistically significant difference in the incidence of postoperative bleeding compared to a known population. There was a significant association of 30-day readmissions with documented evidence of bleeding (P = 0.037). There was no significant change in the preoperative and postoperative serum creatinine. Multivariate logistic regression analysis found no association of postoperative bleeding with pre-existing chronic non-steroidal anti-inflammatory drug (NSAID) use or preoperative serum creatinine. Conclusions Ketorolac is not associated with an increased risk of postoperative bleeding in colorectal ERAS surgical patients. However, postoperative bleeding does predict the likelihood for 30-day readmissions

Volume 21, issue 3

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1154/thumbnail.jp

Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers

The field of endoscopy has revolutionized the diagnosis and treatment of gastrointestinal (GI) diseases in recent years. Besides the ‘traditional’ endoscopic procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography), advances in imaging technology (endoscopic ultrasonography, wireless capsule endoscopy, and double balloon enteroscopy) have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various endoscopic procedures and provides up-to-date endoscopic indications based on the recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care

Early Oral Feeding After Bowel Resection

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery. Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients who were 18 years of age or older, and who underwent elective laparoscopic or open bowel resection. Primary outcome variables were postoperative LOS, return to bowel function, incidence of POI, overall complication rate, and presence of GI symptoms. Exploratory variables included pre-operative preparation techniques (pre-operative fasting, bowel preparation, and pre-medication), analgesic and anesthetic techniques used, laxative use, and nasogastric tube (NGT) reinsertion and time in situ, and time to mobilization. Demographic variables included age, sex, surgery type, incision type, and body mass index (BMI). International Business Machines Statistical Package for Social Sciences (IBM SPSS) and IBM Statistical Package for the Social Sciences Analysis of Moment Structures (IBM SPSS Amos) were used to analyze data. A correlation table and individual linear and binary logistic regressions in SPSS Statistics, and pathway analysis in SPSS Amos were used to determine direct associations, indirect associations, and covariates. Research Results/Findings: There were no significant associations between time to first solid meal and GI complications, sepsis, abscess, or other complications including hemorrhage, hypertensive thrombocytopenia, acute post-hemorrhagic anemia, hematochezia, leukocytosis, colovesical fistula, and prolapse of ileostomy. Time to first solid meal was significantly associated with allowing clear liquids 12 to 24 hours prior to surgery and time to mobilization. Both faster time to first solid diet and eating before bowel function return (BFR) were associated with decreased LOS. In this study, all except two patients received a clear liquid diet (CLD) as their first meal. Forty four percent of patients were not fed orally until after BFR. The NGT was not removed until after postoperative day 1 (POD1) in 25% of patients. Conclusions from Research: The findings in this observational study concur with the findings of previous experimental research. Feeding an early solid meal is not associated with complications and is associated with decreased LOS