Cut Throat Injuries at a University Teaching Hospital in Northwestern Tanzania: A Review of 98 cases.

Cut throat injuries though rarely reported in literature pose a great therapeutic challenge because multiple vital structures are vulnerable to injuries in the small, confined unprotected area. A sudden increase in the number of cut throat patients in our centre in recent years prompted the authors to analyze this problem. This study was conducted in our local setting to describe the etiology, patterns and treatment outcome of these injuries. This was a combined retrospective and prospective study of cut throat injury patients who were managed at Bugando Medical Centre between February 2009 and January 2013. Statistical data analysis was done using SPSS software version 17.0. A total of 98 patients with cut throat injuries were studied. Males outnumbered females by a ratio of 2.4: 1. The median age of patients was 26 years (range 8 to 78 years). Majority of patients (79.6%) had no employment and most of them (65.3%) came from rural community. Homicide was the commonest (55.1%) cause, followed by suicidal attempts (34.7%) and accidental (10.2%) injuries. Interpersonal conflict (24.4%) was the most common motivating factor for homicidal injury whereas psychiatric illness (16.2%) and road traffic accidents (9.2%) were the most frequent motivating factors of suicidal attempt and accidental injuries respectively. The majority of injuries were in Zone II accounting for 65.3% of cases and most of them had laryngeal (57.1%) injury. Surgical debridement, laryngeal/hypopharynx repair and tracheostomy were the most common surgical procedures performed in 93.9%, 73.5% and 70.4% of patients respectively. Postoperative complication rate was 57.1%, the commonest being surgical site infections in 28.1% of patients and it was significantly associated with late presentation and anatomical zones (P < 0.001). The overall median duration of hospitalization was 12 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p = 0.011). Mortality rate was 11.2% and was significantly associated with co-morbidities, delayed presentation and presence of complications (p < 0.001). The follow up of patients was poor. Cut throat injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of these injuries in our environment

Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff

<p>Abstract</p> <p>Background</p> <p>In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments.</p> <p>Methods</p> <p>We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service.</p> <p>Results</p> <p>The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service.</p> <p>Conclusions</p> <p>Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients.</p

Cerebrospinal fluid rhinorrhea - An overview

No Abstract

An Unusual Oronasal Foreign Body: Report of A Case

Background: Foreign body removal in children is very common in the daily routine of an otolaryngologist but reports of oronasal foreign bodies and their management are rare. Method: The case note of a 5 year old female child presenting with an oronasal foreign body following a domestic accident was retrieved and studied and followed up. Result: a 5 year old female child with an oronasal foreign body which created an oronasal fistula that was closed with local palatal mucoperiosteal-lined flaps. The patient defaulted following treatment, a common practice by patients in our society. Conclusion: This report highlights the occurrence of this rare condition, its management and the need to put measures in place to prevent domestic accidents especially for those most at risk. Keywords: Oronasal, Foreign body, Fistula, Domestic accident.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 459-46

Ear care: Knowledge, attitude and practice amongst health professionals at the Jos university teaching hospital

Objective: Our study aims to ascertain the knowledge, attitude and practice of ear care amongst health care givers in our hospital in this cross-sectional study.Methods: In this cross-sectional study, validated questionnaires were filled by health professionals in our Teaching Hospital and analyzed.Results: There were 94 males and 47 females with male to female ratio of 2:1, age ranging between 25 and 59 years (Mean= 42 years; SD=+/- 12.5). Most subjects were between 35 and 39 years and were mostly nurses (n=34, 24.1%). One hundred and twenty nine (91.5%) individuals ‘clean’ their ears with majority of them (n= 48, 37.2%) doing so occasionally. Multiple objects were inserted into the ears by 31 (24.0%) subjects and single objects by 98 (76%). The commonest object inserted into the ears to effect ‘cleaning’ was cotton buds in 115 (89.1%) subjects. Twelve (9.3%) subjects recorded injuries to the ears while ‘cleaning’. A total of 97 (68.8%) subjects had no prior knowledge that it was wrong to insert objects in their ears. Sixty three (44.7%) subjects had cerumen auris. Cotton buds (n=29) was the commonest method of removal. The commonest ototoxic drug used was quinine (n=7; 50%).Conclusion: This study reveals that health care professionals in our center have a poor knowledge and attitude towards the practice of ear care. Health education is therefore required for these and the general populace on the practice of ear care to avoid preventable damages to ears.Key words: Ear Care; Health Professionals; Knowledge; Attitude; Practic

Experience in the management of the mass casualty from the January 2010 Jos Crisis

Background: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident.Objective: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010.Methodology: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010.Results: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point.Conclusion: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.Keywords: Conflict, disaster, hospital response, mass casualty, traum

Oropharyngeal stenosis following traditional uvulectomy- case report of challenges in anesthetic and surgical management

Background: Severe oropharyngeal stenosis (OPS) associated with dysphagia and stunted growth is an unusual complication of traditional uvulectomy in children; an unpopular practicestill occurring in Africa.Methods: We present anaesthetic and surgical challenges in the management of a 19 year old female with this complication scheduled for uvulopharyngoplasty.Results: The peri-operative airway challenge was managed by tracheostomy, which was used for inhalational anaesthesia, and allowed free surgical access of pharynx for the surgeon.Conclusion: Patients with severe OPS will benefit from elective pre-operative tracheostomy, to avoid intubation problems and allow sharing of airway for surgical access.Keywords: Traditional uvulectomy, Oropharyngeal stenosis, Tracheostomy, Uvulopharyngoplast