Death and injury on duty- a study of South African police officers

Objectives. Sections of contemporary South African society are characterised by high levels of crime and interpersonal conflict. The South African Police Service (SAPS) is in the front line, with many deaths and injuries occuring among serving officers in recent years. The circumstances and nature of the injuries sustained by these officers have received little attention in the medical literature.Design. A retrospective review of all injured SAPS members was undertaken at a single level one trauma centre in Johannesburg between June 1993 and June 2002. The following factors were recorded: demographics, mechanism and anatomical site of injury, mode of transportation to hospital, whether personal protection had been used, mortality, and return to work.Results. One hundred and thirty-four SAPS personnel were admitted over a 9-year period. The majority (95%) were male and the median age was 31 years. One hundred and thirty two were on duty and two were in transit to a place of duty when injured. Ninety-two (69%) were injured by gunshot, (including 3 attempted suicides and 9 injuries due to negligent discharge), 2 members were stabbed, 31 were involved in motor vehicle accidents, 2 in motorbike accidents, 1 member was struck by a car while directing traffic, 3 officers were injured by falls from a height, 2 members were injured in helicopter crashes, and 1 member required treatment for gas inhalation. Documentation on whether some form of personal protection was worn at the time of injury was only available for 43 of the 92 cases of gunshot wounds (47%); of these, only 15 (35%) were wearing a bulletproof vest. Use or non-use of a seat belt was documented by hospital staff for only 6 of the 31 officers (19%) injured in motor vehicle accidents. None of the 6 officers had been restrained by a seatbelt. Nineteen SAPS personnel (14%) died of their injuries, but the majority of surviving members returned to duty.Conclusion. There is an unacceptably high level of violence in South African society today and SAPS members regularlyhave to deal with dangerous or violent situations. There is a clear need to introduce a reporting system within the SAPS to record the use of personal protection by officers. Education needs to target SAPS members in order to enhance their use of personal protection. There is a further need to design and implement personal protection that will be universally acceptable by SAPS members

Trauma electives in South Africa provide valuable training for international surgeons

Background. Trauma electives in South Africa (SA) are common and many foreign-based surgeons have undertaken such electives over the past 3 decades. Despite this, little academic attention has been paid to these electives, which remain largely informal and unstructured. This project aims to redress this deficit.Objectives. To investigate and document the extent of trauma clinical electives and to assess their impact on the careers of foreign surgeons who have undertaken such electives.Methods. A mixed methods-style questionnaire was compiled, which sought to document the demographics of surgeons undertaking an SA trauma clinical elective, the trauma clinical experience they had prior to the elective, as well as the volume of experience they acquired during the elective.Results. Sixty questionnaires were sent out and 21 were completed. There were 16 male and 5 female respondents. Only 17 had undertaken a formal trauma rotation before their elective in SA. The mean number of major resuscitations managed prior to rotating through surgery departments in SA was 15, and the mean number managed during a 12-month rotation in SA was 204. It would take each respondent 14 years in their country of origin to acquire an equivalent level of exposure to major resuscitation. During the year before their elective, each surgeon had been exposed to a mean number of the following: 0.5 gunshot wounds (GSWs), 2 stab wounds (SWs), 0.1 blast injuries and 19 road traffic accidents (RTAs). The equivalent mean number for their year in SA was 106 GSWs, 153 SWs, 4 blast injuries and 123 RTAs. The time necessary to achieve a similar level of exposure to their SA experience if they had remained in their country of origin was 213 years for GSWs, 73 years for SWs, 41 years for blast injuries and 7 years for RTAs. Compared with their SA elective, it would take each respondent 3 years to insert as many central venous lines, 9 years to perform the same number of tube thoracostomies, 9 years to manage as many surgical airways, 18 years to explore as many SWs of the neck and 93 years to explore as many GSWs of the neck. Furthermore, it would take 33 years to see and perform as many laparotomies for SWs to the abdomen, 374 years to perform an equivalent number of GSWs to the abdomen and 34 years of experience to perform as many damage-control laparotomies in their countries of origin. In terms of vascular trauma, it would take 23 years to see as many vascular injuries secondary to SWs and 77 years to see an equivalent number of vascular injuries secondary to GSWs.Conclusions. A trauma clinical elective in SA provides an unparalleled exposure to almost all forms of trauma in conjunction with a welldeveloped academic support programme. Formalising these trauma electives might allow for the development of exchange programmes for SA trainees who wish to acquire international exposure to advanced general surgical training

Trauma electives in South Africa provide valuable training for international surgeons

Background. Trauma electives in South Africa (SA) are common and many foreign-based surgeons have undertaken such electives over the past 3 decades. Despite this, little academic attention has been paid to these electives, which remain largely informal and unstructured. This project aims to redress this deficit.Objectives. To investigate and document the extent of trauma clinical electives and to assess their impact on the careers of foreign surgeons who have undertaken such electives.Methods. A mixed methods-style questionnaire was compiled, which sought to document the demographics of surgeons undertaking an SA trauma clinical elective, the trauma clinical experience they had prior to the elective, as well as the volume of experience they acquired during the elective.Results. Sixty questionnaires were sent out and 21 were completed. There were 16 male and 5 female respondents. Only 17 had undertaken a formal trauma rotation before their elective in SA. The mean number of major resuscitations managed prior to rotating through surgery departments in SA was 15, and the mean number managed during a 12-month rotation in SA was 204. It would take each respondent 14 years in their country of origin to acquire an equivalent level of exposure to major resuscitation. During the year before their elective, each surgeon had been exposed to a mean number of the following: 0.5 gunshot wounds (GSWs), 2 stab wounds (SWs), 0.1 blast injuries and 19 road traffic accidents (RTAs). The equivalent mean number for their year in SA was 106 GSWs, 153 SWs, 4 blast injuries and 123 RTAs. The time necessary to achieve a similar level of exposure to their SA experience if they had remained in their country of origin was 213 years for GSWs, 73 years for SWs, 41 years for blast injuries and 7 years for RTAs. Compared with their SA elective, it would take each respondent 3 years to insert as many central venous lines, 9 years to perform the same number of tube thoracostomies, 9 years to manage as many surgical airways, 18 years to explore as many SWs of the neck and 93 years to explore as many GSWs of the neck. Furthermore, it would take 33 years to see and perform as many laparotomies for SWs to the abdomen, 374 years to perform an equivalent number of GSWs to the abdomen and 34 years of experience to perform as many damage-control laparotomies in their countries of origin. In terms of vascular trauma, it would take 23 years to see as many vascular injuries secondary to SWs and 77 years to see an equivalent number of vascular injuries secondary to GSWs.Conclusions. A trauma clinical elective in SA provides an unparalleled exposure to almost all forms of trauma in conjunction with a well-developed academic support programme. Formalising these trauma electives might allow for the development of exchange programmes for SA trainees who wish to acquire international exposure to advanced general surgical training

ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy

A role of PTPN21 in neuron survival and degeneration

This journal suppl. entitled: 2016 Abstract SupplementBACKGROUND: Alzheimer’s disease (AD) chronically leads to dramatic neuronal loss, as they undergo apoptotic cell death, a direct consequence of the b-amyloid deposition or due to damage to their axon. The nervous system has an extremely poor regenerative capabilities and the adult brain’s potential at replacing neurons and regrowing axons is very limited. Therefore, recovering from AD faces many challenges. Moreover, the secondary response at the site establishes a toxic environment, quashing any tentative repair. Previously, our published results revealed that PTPN21 promotes neuron migration and survival via Elk-1 transcription factor, one of the transcription factors of Presenilin 1 (PS1). Henceforth, in this study we explore the potential role of PTPN21 in pathological changes in AD. METHODS: We used our established model of overexpressing PTPN21 or functional lost mutant for PTPN21 and expose the cells to high levels of amyloid precursor protein (APP), and quantify the levels of b-amyloid (1-42 & 1-40), PS1 and other AD’s markers using immunoblotting and ELISA assays. RESULTS: PTPN21 reduces the secretion of b-amyloid and importantly, our preliminary data showing significant PTPN21-dependent reduction of both PS1 levels and human b-Amyloid (1-42). Furthermore, PTPN21 promotes neuron survival through NRG3 pathway. CONCLUSIONS: To this end, our current study uncovered a link between PTPN21 and a specific mechanism of via PS1 to reduce b-amplyoid production, of which, might help to slow the progression of AD.link_to_OA_fulltex