Animal-Related Injuries in a Resource-Limited Setting: Experiences from a Tertiary Health Institution in Northwestern Tanzania.

Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region. This was a descriptive prospective study of animal related injury patients that presented to Bugando Medical Centre between September 2007 and August 2011. Statistical data analysis was done using SPSS computer software version 17.0. A total of 452 (8.3%) animal-related injury patients were studied. The modal age group was 21-30 years. The male to female ratio was 2.1:1. Dog-bites (61.1%) were the most common injuries. Musculoskeletal (71.7%) region was the most frequent body region injured. Soft tissue injuries (92.5%) and fractures (49.1%) were the most common type of injuries sustained. Only 140 (31.0%) patients were hospitalized and most of them (97.1%) were treated surgically. Wound debridement was the most common procedure performed in 91.2% of patients. Postoperative complication rate was 15.9%, the commonest being surgical site infections (SSI) in 55.1% of patients. SSI was significantly associated with late presentation and open fractures (P < 0.001). The overall median duration of hospitalization was 16 days. Patients who had severe injuries, long bone fractures and those with hemiplegia stayed longer in the hospital (P < 0.001). Mortality rate was 10.2% and was significantly high in patients with severe injuries, severe head injury, tetanus and admission SBP < 90 mmHg (P < 0.001). The follow up of patients was poor. Animal related injuries constitute a major public health problem in our setting and commonly affect the young adult male in their economically productive age-group. Measures towards prevention and proper treatment and follow up are important in order to reduce morbidity and mortality resulting from this form of trauma

Ear, nose and throat injuries at Bugando Medical Centre in northwestern Tanzania: a five-year prospective review of 456 cases.

Injuries to the ear, nose and throat (ENT) regions are not uncommon in clinical practice and constitute a significant cause of morbidity and mortality in our setting. There is dearth of literature on this subject in our environment. This study was conducted to describe the causes, injury pattern and outcome of these injuries in our setting and proffer possible preventive measures. This was a descriptive prospective study of patients with ear, nose and throat injuries managed at Bugando Medical Centre between May 2007 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was performed using SPSS computer software version 17.0. A total of 456 patients were studied. The median age of patients at presentation was 18 years (range 1 to 72 years). The male to female ratio was 2:1. The commonest cause of injury was foreign bodies (61.8%) followed by road traffic accidents (22.4%). The ear was the most common body region injured accounting for 59.0% of cases. The majority of patients (324, 71.1%) were treated as an outpatient and only 132(28.9%) patients required admission to the ENT wards after definitive treatment. Foreign body removal and surgical wound debridement were the most common treatment modalities performed in 61.9% and 16.2% of cases respectively. Complication rate was 14.9%. Suppurative otitis media (30.9%) was the commonest complication in the ear while traumatic epistaxis (26.5%) and hoarseness of voice (11.8%) in the aero-digestive tract were commonest in the nose and throat. The overall median length of hospital stay for in-patients was 8 days (range 1 to 22 days). Patients who developed complications and those who had associated injuries stayed longer in the hospital (P < 0.001).Mortality rate related to isolated ENT injuries was 1.3% (6 deaths). The majority of patients (96.9%) were treated successfully and only 3.1% of cases were discharged with permanent disabilities. Injuries to the ENT regions are not uncommon in our environment and foreign bodies constitute a significant cause of injury. Majority of these injuries can be prevented through public enlightenment campaigns

Real-time patient satisfaction of emergency department services in a tertiary-care hospital in Karachi, Pakistan

Background: In Emergency Department (ED), patient satisfaction is an important quality indicator. The aim of this study was to assess the patient satisfaction with ED services using real- time patient satisfaction survey. Methods: The study was conducted for two weeks in the ED of Aga Khan University in December 2011. A structured questionnaire was used to capture patient’s feedback on service quality in the ED. Patient response was recorded using five-level Likert scale; strongly agree, agree, neutral, disagree and strongly disagree. Respondents were either patients or their relatives. Results: Total 348 real-time survey forms were completed. Of these 18.6% (n=61) were in P1 triage category, 32.6% (n=107) in P2 and 48.8% (n=160) were P3 patients. An overall satisfaction rate was 4.27 with satisfactory response from 84.6% patients with ED services. About 87.7% of patients were satisfied with time taken to be attended by the triage staff at the counter, Time taken to get an ED bed was 86.8% and time taken until beginning of treatment after getting an ED bed is 84.3%. Conclusion: Patient satisfaction is an important quality indicator which enables to identify areas of improvement in ED so as to provide better care & services to patients

Spectrum of Gunshot Injuries in Civilian Practice at a Tertiary Hospital in a Semi-rural Community in Nigeria

Background: Gunshot injuries are common. Political and ethno-religious conflicts have made injuries from ballistics now commonplace in Nigeria. Data was collected prospectively at Federal Medical Centre Owo, South Western Nigeria from September 2007 to August 2011. The objective was to highlight the nature of gunshot wounds, patients’ and gun  characteristics, and document the outcome of treatment upon discharge.Methods: All patients with gunshot injuries (GSI) admitted via the emergency room (ER) of the hospital. Outcome measures included the status upon leaving the hospital: Alive and discharged home without disability; alive and discharged home with some disability; discharged against medical advice; referral to another hospital and death. Data was analyzed using SPSS17 programfor frequencies, measure of central tendencies and relationships.Results: A total of 139 patients were seen. Males accounted for 94.2% of the victims. The ages ranged from 12 to 70 years (mean = 33.14 years); modal age group was 21-40 years (76.3%). High velocity injuries were common (59%). Armed robbery (56.1%), accidental discharge (20.1%) and assault (11.5%) were major sources. Injuries involved the limbs (54.7%), trunk (10.1%), and &gt; one region (22.3%). About 62% of cases presented within 8hours of injury. The mortality and limb deformity rates were 5.8% and 14.4% respectively. Outcome of treatment depended on promptness of definitive care and the nature of injuries at presentation (p= 0.001 and p=0.026 respectively).Conclusion: Injuries from high velocity guns were common. Armed robbery, assault and accidental discharge from law enforcement agents were the major sources. Outcome was dependent on the nature of injuries and the promptness of intervention.Keywords: Injuries, Civilian, Gunshot

An autopsy study of road traffic accident cases at tertiary care center, Mandya, Karnataka

Background: Road traffic accidents represent a pervasive global crisis resulting in the loss of millions of lives and countless injuries annually. According to the world health organization (WHO), over 1.3 million people die in road traffic accident every year, and an additional 20-50 million are injured or disabled. Objective was to study the demographic patterns in these cases of RTA in and around AIMS B. G. Nagar, India. Methods: It was a cross sectional study of all medico legal necropsies of road traffic accidents, Data was collected between January 2022 to June 2023 at the mortuary of the department of forensic medicine and toxicology, AIMS, B. G. Nagar, and Karnataka, India. Collected data was analysed. Results: During the study period 117 (40.20%) were road traffic accidents, according to this study road traffic accidents were more 30 (25.64%) in old age groups and males 105 (89.74%) were majorly affected. Majority of the accidents 41 (35%) predominantly occurred during evening to midnight hours on highways 65 (55.55%), light vehicles (37.61%) were most frequently engaged in road traffic accident and the most common site of injury was head 98 (83.76%), and cause of death was due to intracranial hemorrhages (49.57%) and among the pattern of intracranial hemorrhage we observed high number of (32.47%) combination of subdural hemorrhages and sub-arachnoid hemorrhages. Conclusions: Through this study we want to create awareness and deploy safety measures to prevent RTA

A clinical profile of liver function tests in COVID-19 patients at tertiary care centre from north India

Background: The coronavirus is a large group of virus, which spread rapidly as an epidemic in china and was named initially as 2019 novel corona virus and subsequently named as Coronavirus disease 2019 (COVID-19) by World Health Organization (WHO). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a dramatic loss of human life globally and manifests a variety of clinical symptoms varying from fever, cough, headache, myalgias, nausea, vomiting to more severe pneumonia, ARDS, septic shock and multiorgan failure. SARS-CoV-2, primarily affect respiratory system but COVID-19 patients also have varying levels of liver injuries or liver dysfunction. This retrospective study was designed to analyze the clinical features, liver function and duration of hospital stay with confirmed cases of covid-19 in a tertiary care centre.Methods: We conducted a cross-sectional study in the Isolation ward, Level -2 Covid Hospital, Government Medical College, Kannauj, Uttar Pradesh (India), from April to June 2021. A detailed history and examination was carried out as per the pre-designed proforma. The liver function test included alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin. Patients were considered with abnormal LFTs when any value of these tests was higher than upper limit of normal.Results: One hundred and ten patients with covid-19 were enrolled during the study period. There were 74 males (67.2%) and 36 (32.7%) females.  The mean age of study population was 49.07±12.05 years. In present study, the mean value of serum bilirubin, SGPT, SGOT and ALP were 0.85±0.47 mg/dl, 74.6±66.9 IU/L, 48.45±36.86 IU/L and 229.25±69.79 IU/L, respectively. In present study, the abnormal liver function was seen in 67.2 % cases with COVID-19 patients. The mean duration of hospital stay among normal LFT and abnormal LFT patients group were 13.33±2.12 and 17.10±2.07 days, respectively.Conclusions: The present study highlighted that abnormal liver function was observed in 67.2% cases with COVID-19 patients. Further research should focus on the cause of liver injury in covid 19 and on treatment and outcome

Scope And Outcomes Of A Trauma Quality Improvement Program At Royal Prince Alfred Hospital, Australia 2006-2016

Background Injury and trauma remain important causes of morbidity and mortality globally. Trauma systems have been established to facilitate optimal management of injured patients, including timely access to specialist trauma centres in those who are severely injured. Trauma quality improvement programs have emerged over the past decade to evaluate and improve quality of care delivered by trauma systems and trauma centres. Despite this, there remains little evidence to demonstrate that these quality improvement programs actually improve patient outcomes or whether they are cost-effective. In 2006, a trauma quality improvement program was initiated at Royal Prince Alfred Hospital, Australia. This consisted primarily of the implementation of trauma team activation and resuscitation protocols, and the evaluation of care through the use of clinical indicators (key performance indicators) and measurement of post discharge health status. Objectives This thesis describes a quality improvement program at Royal Prince Alfred Hospital that involved monitoring of all major clinical services involved in the acute care of trauma at this hospital, and evaluates this program with respect to in-patient mortality for severe injury, cost effectiveness and long term outcomes. Methods The studies were conducted at Royal Prince Alfred Hospital (RPA) in New South Wales Australia. The thesis is presented in four main sections. The first section (chapters 1 to 4) provides an outline of the thesis and summarises the current literature on trauma quality improvement programs. Preliminary papers describe the historical context of the trauma service at this institution and discuss the conceptual framework for trauma patient data collection. The second section (chapters 5 to 9) provides background information regarding contemporaneous trends in injury presentations to Emergency Departments and major trauma activity and mortality across NSW. The third section (chapters 10 to 13) details and evaluates the impact of the trauma quality improvement program on long-term major trauma mortality trends at this hospital using time series analysis and its cost effectiveness in a subset of road trauma patients. It also investigates health status outcomes in trauma patients at three and six months after hospital discharge - a project initiated as part of the quality improvement program. Results Injury is one of the leading causes of presentations to Emergency Departments across NSW and the critically injured make up around 1% of total injury presentations. Major trauma in-hospital mortality across NSW has remained stable at around 16% between 2003 and 2014. The trauma quality improvement program at RPA was associated with a significant reduction in major trauma mortality from 16% to 10% after 2007. The incremental cost effectiveness was estimated to be $7600 per year of life saved in the subset of road trauma patients. Analyses of health outcomes after discharge revealed increasing injury severity and upper limb injuries were the only predictors of reduced employment status after injury, and lower limb injuries were associated with reduced physical health status compared to those without lower limb injuries at both 3 and 6 months post discharge. Around 37% of patients reported signs of psychological distress and this did not change significantly during the study interval. Conclusions This thesis has published important new information regarding the clinical and cost-effectiveness of trauma quality improvement programs. It contains the first published studies evaluating these interventions using formal time series and health economics analysis and one of few reporting the intervention in the context of existing injury and trauma management systems in New South Wales Australia