Experience of domestic violence by women attending an inner city accident and emergency department.

OBJECTIVES: To identify the prevalence of domestic violence (DV) (defined as physical abuse perpetrated by intimate partners) in women attending an inner city accident and emergency department and to elicit women's response about being asked routinely about domestic violence in this setting. METHODS: 22 nursing shifts were purposefully sampled to be representative of day, night, and weekends. A questionnaire was administered to 198 consenting women who were not intoxicated, confused, or critically ill. RESULTS: The prevalence of acute trauma in women attributable to DV was 1% (95%CI 0.14 to 3.6), the prevalence of lifetime physical abuse was 34.8% (95%CI 28.2 to 41.5), of past year physical abuse was 6.1% (95%CI 3.2 to 10.3), and of lifetime life threatening physical abuse was 10.6% (95%CI 6.3 to 14.9). Seventy six per cent of women felt comfortable about being asked about DV and 60.5% of women felt that they should always or usually be asked about DV in this setting. CONCLUSION: This cross sectional survey adds to the body of knowledge showing that the prevalence of DV in women attending an accident and emergency department is high. Most women were in favour of being asked, and disclosure was associated with discomfort in few women. This sensitive area of history taking and referral could be undertaken by health professionals using a supportive approach

Respirator treatment of crushed chest injuries

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Disodium Cromoglycate (Lomudal) in Asthma with Emphasis on Lung Function Tests

Twenty allergic asthmatics were treated with inhaled disodium cromoglycate (Lomudallt in addition to extant therapy. Improvement was assessed by the patient, clinically by the physician, by analysis of the patients' diary cards and by a battery of pulmonary function tests, after 3 months' treatment. Eighteen patients were improved. At the end of 1 year's treatment, only 1 failed to maintain improvement. No serious side-effects were encountered. Lung function tests demonstrated less hyperinflation in 9 out of 11 patients tested, less airway obstruction in 14 out of 20, no change in a standardized exercise test and an improvement in acid-base balance from compensated respiratory alkalosis to normal. The results in this trial are discussed in relation to others in this literature. The value of DSCG in facilitating reduction of corticosteroid and sympathomimetic therapy for asthma is emphasized. Some practical points in the use of DSCG are listed. Disodium cromoglycate is safe and efficacious in allergic bronchial asthma and is a very useful adjunct in the therapy of this common, potentially serious condition

Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study

Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March–May 2020; May–November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers

The introverted medical school - time to rethink medical education

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The lung in progressive systemic sclerosis (scleroderma)

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Alpha1-antitrypsin deficiency

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Changing the malaria treatment protocol policy in Timor-Leste: an examination of context, process, and actors’ involvement

In 2007 Timor-Leste, a malaria endemic country, changed its Malaria Treatment Protocol for uncomplicated falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. The change in treatment policy was based on the rise in morbidity due to malaria and perception of increasing drug resistance. Despite a lack of nationally available evidence on drug resistance, the Ministry of Health decided to change the protocol. The policy process leading to this change was examined through a qualitative study on how the country developed its revised treatment protocol for malaria. This process involved many actors and was led by the Timor-Leste Ministry of Health and the WHO country office. This paper examines the challenges and opportunities identified during this period of treatment protocol change

Recent Experiences in the Respiratory Unit of the Johannesburg Hospital

The importance of respiratory disease in medicine is emphasized. One hundred and thirtyfive cases were referred to the Respiratory Unit in a 5-month period. These cases 'have been analysed in terms of age, sex and major disease. Fifty-six patients,of whom 47 had intermittent positive pressure respiration, required treatment in an intensive care unit. Twenty-two patients died in the intensive care unit-a mortality rate of 39%. Also discussed and briefly illustrated are problems of intermittent positive pressure respiration, tracheostomy and endotracheal intubation, cardiac arrhythmias, oxygen toxicity, fat embolism and tetanus