Trauma unit emergency doctor airway management

Objectives. To audit indications for and practice (in terms of training/qualification) of definitive airway management compared with current UK practices. Design. Consecutive observational study. Setting. Tygerberg Academic Hospital Trauma Service, Western Cape. Subjects. All trauma patients either arriving intubated or requiring intubation at the Trauma unit during the period 1 - 31 August 2006. Outcome measures. A data collection proforma was completed either at the time of intubation or from medical records. Results. Fifty-seven patients required definitive airway management. In the unit 32 patients (56%) were intubated by emergency medicine registrars or medical officers, with rapidsequence intubations (RSIs) in all 32 (100%). Seven patients (12.3%) were intubated by paramedics pre-hospital, and 18 patients (31.6%) were intubated at referring hospitals by nonanaesthetists. Endotracheal intubation was successful in 55 patients (96.4%). Two patients (3.6%) could not be intubated and therefore underwent surgical cricothyroidotomy at the unit. Clinical outcomes included 12 patients (21%) extubated for ward transfer, 7 patients (12.3%) admitted to an intensive care unit (ICU), 21 patients (36.8%) taken for surgery, and 17 patients (29.8%) died. Motor vehicle accident (MVA) was the predominant mechanism of injury, accounting for 30 (52.6%) patients, while 16 patients (28.1%) had penetrating injuries (gunshot and/or stab wounds), 6 patients (10.5%) had blunt trauma, and the remaining 5 patients (8.8%) suffered serious burns. Conclusion. The most common indication for intubation was a Glasgow Coma Score (GCS) of less than 8, typically in the polytrauma patient with suspected head injury due to MVA. Emergency doctors managed 100% of definitive airway inhospital, and RSI was the favoured method. This differs greatly from the UK where non-anaesthetists only perform between 31% and 56% of trauma intubations, with the rest performed by anaesthetists. Outcome was, however, similar to that described in the literature. South African Medical Journal Vol. 97 (9) 2007: pp. 864-86

Complications relating to enteral and parenteral nutrition in trauma patients: a retrospective study at a level one trauma centre in South Africa

Objectives: The aim of the study was to compare the incidence of complications in patients receiving enteral and parenteral nutrition (PN), and review how the early initiation of enteral feeding and early achievement of caloric goal would affect the incidence of complications.Design: The design was a retrospective audit of an ethics-approved prospective trauma registry and electronic medical record.Setting: The setting was a level one trauma centre intensive care unit.Subjects: One thousand and two consecutively treated patients were selected from 1 096 in the database.Outcome measures: Demographic data, nutrition, route of administration, time of initiation and complications in the form of sepsis, pneumonia and feed intolerance, were determined.Results: Patients receiving total PN (TPN) during their length of stay had a hazard ratio of 9.11 for the development of sepsis, compared to patients who were solely fed via the enteral route (p-value <0.001). The patients who reached their nutritional goal late showed a hazard ratio of 2.67 for the development of sepsis, compared to patients who reached the goal early (p-value < 0.001). Patients with late initiation of feeding also had a greater risk of developing sepsis, with a hazard ratio of 2.41, compared to patients with early initiation (p-value < 0.001). Patients achieving the nutritional goal late had a 17.9% increased risk of developing pneumonia (p-value < 0.001).Conclusion: This study confirms previous findings that the use of TPN is a strong predictor of the development of sepsis, compared to enteral nutrition. Causality linkage should be made with caution owing to the study design.Keywords: complications, critical illness, nutrition, trauma, outcom

Untangling cosmic magnetic fields: Faraday tomography at metre wavelengths with LOFAR

14 pages, 6 figures. Accepted for publication in "The Power of Faraday Tomography" special issue of GalaxiesThe technique of Faraday tomography is a key tool for the study ofmagnetised plasmas in the new era of broadband radio-polarisation observations. In particular, observations at metre wavelengths provide significantly better Faraday depth accuracies compared to traditional centimetre-wavelength observations. However, the effect of Faraday depolarisationmakes the polarised signal very challenging to detect at metre wavelengths (MHz frequencies). In this work, Faraday tomography is used to characterise the Faraday rotation properties of polarised sources found in data from the LOFAR Two-Metre Sky Survey (LoTSS). Of the 76 extragalactic polarised sources analysed here, we find that all host a radio-loud AGN (Active Galactic Nucleus). The majority of the sources (~64%) are large FRII radio galaxies with a median projected linear size of 710 kpc and median radio luminosity at 144 MHz of 4 × 10 26 W Hz -1 (with ~13% of all sources having a linear size > 1 Mpc). In several cases, both hotspots are detected in polarisation at an angular resolution of ~20'. One such case allowed a study of intergalactic magnetic fields on scales of 3.4 Mpc. Other detected source types include an FRI radio galaxy and at least eight blazars. Most sources display simple Faraday spectra, but we highlight one blazar that displays a complex Faraday spectrum, with two close peaks in the Faraday dispersion function.Peer reviewe

Blue cone monochromacy: causative mutations and associated phenotypes.

PurposeTo perform a phenotypic assessment of members of three British families with blue cone monochromatism (BCM), and to determine the underlying molecular genetic basis of disease.MethodsAffected members of three British families with BCM were examined clinically and underwent detailed electrophysiological and psychophysical testing. Blood samples were taken for DNA extraction. Molecular analysis involved the amplification of the coding regions of the long (L) and medium (M) wave cone opsin genes and the upstream locus control region (LCR) by polymerase chain reaction (PCR). Gene products were directly sequenced and analyzed.ResultsIn all three families, genetic analysis identified that the underlying cause of BCM involved an unequal crossover within the opsin gene array, with an inactivating mutation. Family 1 had a single 5'-L-M-3' hybrid gene, with an inactivating Cys203Arg (C203R) mutation. Family 3 had an array composed of a C203R inactivated 5'-L-M-3' hybrid gene followed by a second inactive gene. Families 1 and 3 had typical clinical, electrophysiological, and psychophysical findings consistent with stationary BCM. A novel mutation was detected in Family 2 that had a single hybrid gene lacking exon 2. This family presented clinical and psychophysical evidence of a slowly progressive phenotype.ConclusionsTwo of the BCM-causing family genotypes identified in this study comprised different hybrid genes, each of which contained the commonly described C203R inactivating mutation. The genotype in the family with evidence of a slowly progressive phenotype represents a novel BCM mutation. The deleted exon 2 in this family is not predicted to result in a shift in the reading frame, therefore we hypothesize that an abnormal opsin protein product may accumulate and lead to cone cell loss over time. This is the first report of slow progression associated with this class of mutation in the L or M opsin genes in BCM

Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study

We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment

Global surgery : a South African action plan

CITATION: Hardcastle, T. C. & Chu, K. M. 2020. Global surgery : a South African action plan. South African Journal of Surgery, 58(4):176-177, doi:10.17159/2078-5151/2020/v58n4a3502.The original publication is available at: https://journals.co.zaENGLISH ABSTRACT: Global surgery is the study, research, and practice of improving access for all people to quality and timely surgical care locally and transnationally. This relatively new academic field was kick started in 2015 with the launch of the Lancet Commission on Global Surgery1 and a World Health Assembly declaration that essential and emergency surgical care (EESC) is an essential component of universal health coverage.2 What does global surgery mean to the South African surgeon and how can it improve healthcare provision for surgical conditions within our region? Surgical care is an indispensable, cross-cutting health service that is necessary to improve health in diverse areas, such as cancer, injury, cardiovascular disease, infection, and maternal/child health. The high burden of trauma, noncommunicable diseases (including cancer), maternal and child-health challenges, and communicable diseases (HIV and TB in particular) are a quadruple threat to the health and well-being of South Africans.3 Poor access to highquality surgical, obstetric and anaesthesia care remains a major contributor to the global disease burden, accounting for large numbers of deaths worldwide.Publisher's versio

Self-reported quality of care for older adults from 2004 to 2011: a cohort study

Background: little is known about changes in the quality of medical care for older adults over time. Objective: to assess changes in technical quality of care over 6 years, and associations with participants' characteristics. Design: a national cohort survey covering RAND Corporation-derived quality indicators (QIs) in face-to-face structured interviews in participants' households. Participants: a total of 5,114 people aged 50 or more in four waves of the English Longitudinal Study of Ageing. Methods: the percentage achievement of 24 QIs in 10 general medical and geriatric clinical conditions was calculated for each time point, and associations with participants' characteristics were estimated using logistic regression. Results: participants were eligible for 21,220 QIs. QI achievement for geriatric conditions (cataract, falls, osteoarthritis and osteoporosis) was 41% [95% confidence interval (CI): 38–44] in 2004–05 and 38% (36–39) in 2010–11. Achievement for general medical conditions (depression, diabetes mellitus, hypertension, ischaemic heart disease, pain and cerebrovascular disease) improved from 75% (73–77) in 2004–05 to 80% (79–82) in 2010–11. Achievement ranged from 89% for cerebrovascular disease to 34% for osteoarthritis. Overall achievement was lower for participants who were men, wealthier, infrequent alcohol drinkers, not obese and living alone. Conclusion: substantial system-level shortfalls in quality of care for geriatric conditions persisted over 6 years, with relatively small and inconsistent variations in quality by participants' characteristics. The relative lack of variation by participants' characteristics suggests that quality improvement interventions may be more effective when directed at healthcare delivery systems rather than individuals

The fading of two transient ultraluminous x-ray sources to below the stellar mass Eddington limit

We report new detections of the two transient ultraluminous X-ray sources (ULXs) in NGC 5128 from an ongoing series of Chandra observations. Both sources have previously been observed L (2-3) × ∼10 erg s, at the lower end of the ULX luminosity range. The new observations allow us to study these sources in the luminosity regime frequented by the Galactic black hole X-ray binaries (BH XBs). We present the recent lightcurves of both ULXs. 1RXH J132519.8-430312 (ULX1) was observed at L 1 × 10 erg s, while CXOU J132518.2-430304 (ULX2) declined to L 2 × 10 erg s and then lingered at this luminosity for hundreds of days. We show that a reasonable upper limit for both duty cycles is 0.2, with a lower limit of 0.12 for ULX2. This duty cycle is larger than anticipated for transient ULXs in old stellar populations. By fitting simple spectral models in an observation with ∼50 counts we recover properties consistent with Galactic BH XBs, but inconclusive as to the spectral state. We utilize quantile analyses to demonstrate that the spectra are generally soft, and that in one observation the spectrum of ULX2 is inconsistent with a canonical hard state at >95% confidence. This is contrary to what would be expected of an accreting intermediate mass black hole primary, which we would expect to be in the hard state at these luminosities. We discuss the paucity of transient ULXs discovered in early-type galaxies and excogitate explanations. We suggest that the number of transient ULXs scales with the giant and sub-giant populations, rather than the total number of XBs.Peer reviewe

Revived Fossil Plasma Sources in Galaxy Clusters

© 2020 ESO.It is well established that particle acceleration by shocks and turbulence in the intra-cluster medium can produce cluster-scale synchrotron emitting sources. However, the detailed physics of these particle acceleration processes is still not well understood. One of the main open questions is the role of fossil relativistic electrons that have been deposited in the intracluster medium (ICM) by radio galaxies. These synchrotron-emitting electrons are very difficult to study as their radiative lifetime is only tens of Myr at gigahertz frequencies, and they are therefore a relatively unexplored population. Despite the typical steep radio spectrum due to synchrotron losses, these fossil electrons are barely visible even at radio frequencies well below the gigahertz level. However, when a pocket of fossil radio plasma is compressed, it boosts the visibility at sub-gigahertz frequencies, creating what are known as radio phoenices. This compression can be the result of bulk motion and shocks in the ICM due to merger activity. In this paper we demonstrate the discovery potential of low-frequency radio sky surveys to find and study revived fossil plasma sources in galaxy clusters. We used the 150 MHz TIFR GMRT Sky Survey and the 1.4 GHz NVSS sky survey to identify candidate radio phoenices. A subset of three candidates was studied in detail using deep multi-band radio observations (LOFAR and GMRT), X-ray obserations (Chandra or XMM-Newton), and archival optical observations. Two of the three sources are new discoveries. Using these observations, we identified common observational properties (radio morphology, ultra-steep spectrum, X-ray luminosity, dynamical state) that will enable us to identify this class of sources more easily, and will help us to understand the physical origin of these sources.Peer reviewedFinal Accepted Versio

Remnant radio-loud AGN in the Herschel-ATLAS field

Only a small fraction of observed active galactic nuclei (AGN) display large-scale radio emission associated with jets, yet these radio-loud AGN have become increasingly important in models of galaxy evolution. In determining the dynamics and energetics of the radio sources over cosmic time, a key question concerns what happens when their jets switch off. The resulting ‘remnant' radio-loud AGN have been surprisingly evasive in past radio surveys, and therefore statistical information on the population of radio-loud AGN in their dying phase is limited. In this paper, with the recent developments of Low-Frequency Array (LOFAR) and the Very Large Array, we are able to provide a systematically selected sample of remnant radio-loud AGN in the Herschel-ATLAS field. Using a simple core-detection method, we constrain the upper limit on the fraction of remnants in our radio-loud AGN sample to 9 per cent, implying that the extended lobe emission fades rapidly once the core/jets turn off. We also find that our remnant sample has a wide range of spectral indices (−1.5 ⩽ α1400150 ⩽ −0.5), confirming that the lobes of some remnants may possess flat spectra at low frequencies just as active sources do. We suggest that, even with the unprecedented sensitivity of LOFAR, our sample may still only contain the youngest of the remnant population