Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers

Exploring the Global Health and Defence Engagement Interface

Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. Whilst the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. Whilst there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement

We still need to operate at night!

Research articl

Access to quality care after injury in Northern Malawi:results of a household survey

Background Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury.MethodsWe administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (&gt; 30 or 1-29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 hours. The reason for those not seeking care was asked. ResultsMost households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 hours. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p&lt;0.001), stayed overnight at a facility (22.9% vs 15.4% P=0.047), attended a second place of care (50.3% vs 19.9%, P&lt;0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142).ConclusionInjuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care. <br/

Case Study: The Conservative Management and Rehabilitation of Insertional Patella Tendinopathy in an Elite Footballer

Background and Purpose: Chronic insertional patella tendinopathy is a complex condition to manage within elite athletes. Pain and symptoms increase when spikes or changes in relation to training or game load are experienced. These spikes are often seen in football on return to training or in periods of fixture congestion, presenting a contemporary challenge for the sports medicine team. Study Design: Case Study. Case Description: The presented case summarises the conservative rehabilitation and pain free return to play of a 24 years (yrs) old elite professional footballer with a long-standing history of patella tendinopathy. Symptoms returned post a spike in training load during pre-season, with a diagnosis of a 7.4 mm insertional thickening detected through magnetic resonance imaging. Presented is a summary of the assessment process, 24-week treatment and rehabilitation protocol and subsequent 12-week pre-habilitation plan, routinely completed on return to training and game play. Outcomes: The implemented management strategy led to the successful symptom free return to play of the athlete. Conclusion: The management of this injury was facilitated through subjective and objective assessment markers and imaging obtained to manage the athlete’s symptoms. The authors suggest that medical and conditioning based specialists could apply a rounded loading approach with prescribed isometric and isotonic drills before progression to energy release and pitch-based training to advance the athlete through a safe and controlled return to sport clearance

Development and optimisation of a sex pheromone lure for monitoring populations of saddle gall midge, Haplodiplosis marginata

Saddle gall midge, Haplodiplosis marginata (von Roser) (Diptera: Cecidomyiidae), is a sporadic pest of cereals in Northern and Central Europe and is of increasing importance in the UK. Recently the major component of the sex pheromone produced by adult female H. marginata was reported to be 2-nonyl butyrate. The importance of absolute configuration on attractiveness, the effects on trap catches of the addition of minor pheromone components, dispenser type, and pheromone loading are described in the development of an optimised pheromone lure with which to trap H. marginata males. In analyses of volatiles collected from virgin female H. marginata by gas chromatography (GC) coupled to electroantennographic recording (EAG) from the antenna of a male H. marginata, two EAG responses were observed. Analyses by coupled GC-mass spectrometry (MS) indicated these were due to 2-nonyl butyrate and a trace amount (1%) of 2-heptyl butyrate. A similar trace amount of 2-nonanol was detected in GC-MS analyses but this compound did not elicit an EAG response when the synthetic compound was tested, whereas while the other two compounds did. These three compounds were not observed in collections of volatiles made from male H. marginata. The 2-nonyl butyrate was shown to be the (R)-enantiomer, and i. In field trapping tests (R)-2-nonyl butyrate was at least ten times10× more attractive to male H. marginata than the racemic compound, and while the (S)-enantiomer was unattractive. Addition of the potential minor components individually or together at the naturally -occurring ratios did not increase or reduce the attractiveness of the lure. Polyethylene vials and rubber septa were equally effective as pheromone dispensers, lasting for at least five 5 weeks in the field in the UK, although laboratory tests indicated release from the former was more uniform and more likely to last longer in the field. Increasing loading of pheromone in the dispenser increased attractiveness. Traps baited with polyethylene vials containing 0.5 mg of (R)-2-nonyl butyrate are recommended for monitoring H. marginata and these are far more sensitive than water or sticky traps currently used for monitoring this pest

Reasons to pursue a career in medicine: a qualitative study in Sierra Leone.

BACKGROUND: Many low-income and crises-affected countries like Sierra Leone struggle with the recruitment and retention of their health professionals, particularly nurses and doctors. There are multiple factors that influence the 'recruitment to retention' pipeline. The first stage of an exploration into the issues influencing the availability of qualified health care workers may focus on the aspects which influence their entry into relevant educational programmes. This paper explores the reasons given by junior doctors in Sierra Leone for wanting to become a doctor. It also describes entry procedures into undergraduate medical education. METHODS: In-depth interviews were conducted with purposively sampled junior doctors (n = 15) from the only medical school in Sierra Leone in October 2013. Digital diaries and two follow-up interviews were used to explore their evolving career experiences and aspirations until November 2016. In addition, semi-structured interviews with key informants (n = 20), including senior teaching staff at the medical school (n = 7), were conducted. Thematic analysis was used to explore linkages and themes across cases. RESULTS: Six themes were identified. The most commonly mentioned reasons for wanting to become a doctor were a desire to help (theme 4) and the influence of family and friends, via role modelling (theme 2) and verbal encouragement (theme 3). Other motives were an interest from a young age (theme 1), being attracted by the job prospects (theme 5), and having an intellectual and science capacity (theme 6). Junior doctors gave at least two and up to six reasons for applying to enter the medical profession. Doctors were allowed entry to the medical school largely based on their previous academic performance. CONCLUSIONS: This study showed that multiple reasons underlie the decision to apply for entrance to medical school and the decision to enter medicine is complex. These findings may inform the review of future admission procedures by the medical school in Sierra Leone and similar settings, which is a crucial step in addressing the human resource needs for healthcare that currently exist