The global burden of injury surpasses those of HIV/AIDS, malaria and tuberculosis combined.1 However, trauma systems development is massively underfunded, accounting for only 0.02% of global ...development assistance for care.2 The majority of countries in sub-Saharan Africa (SSA) face substantial gaps in trauma care services, with significant challenges in clinical care, education, training and quality assurance programs.3 Addressing the global burden of injury requires comprehensive efforts to strengthen the trauma chain of survival, including prehospital care, resuscitation, definitive treatment and rehabilitation.4 Despite efforts to improve global access to trauma care, trauma rehabilitation services remain widely unavailable in SSA.5 A lack of data about the long-term functional outcomes of patients with trauma in LMICs, where patients with disabilities are at especially high risk of being lost to follow up, poses a significant challenge for trauma rehabilitation capacity building and advocacy. Diseases and injuries collaborators. global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Long-term follow-up of pediatric head trauma patients treated at mulago national referral hospital in Uganda.
Nonmalignant tracheal stenosis is a potentially life threatening conditions that develops as fibrotic healing from intubation, tracheostomy, caustic injury or chronic infection processes like ...tuberculosis. This is a report of our experience of its management with tracheostomy, rigid bronchoscopic dilation and surgery.
Retrospective study design was used. 60 patients treated over five years period were included.
Mean age was 26.9 ± 10.0 with a range of 10-55 years. Majority (56 patients (93.3%)) had previous intubation as a cause for tracheal stenosis. Mean duration of intubation was 13.8 days (range from 2 to 27 days). All patients were evaluated with neck and chest CT (Computed Tomography) scan. Majority of the stenosis was in the upper third trachea - 81.7%. Mean internal diameter of narrowest part was 5.5 ± 2.5 mm, and mean length of stenosed segment was 16.9 ± 8 mm. Tracheal resection and end to end anastomosis (REEA) was the most common initial modality of treatment followed by bronchoscopic dilation (BD) and primary tracheostomy (PT). The narrowest internal diameter of the tracheal stenosis (TS) for each initial treatment category group was 4.4 ± 4.3 mm, 5.1 ± 1.9 mm and 6.7 ± 1.6 mm for PT, tracheal REEA and BD respectively, and the mean difference achieved statistical significance, F (10,49) = 2.25, p = 0.03. Surgery resulted in better outcome than bronchoscopic dilation (89.1% vs. 75.0%).
Nonmalignant tracheal stenosis mostly develops after previous prolonged intubation. Surgical resection and anastomosis offers the best outcome.
The study aimed to assess the magnitude, risk factors, and management outcome of patients with a bronchopleural fistula at multiple centres in Ethiopia.
A ten years (September 2012 - August 2021) ...institution-based multicenter retrospective cohort study was conducted from September 13 to September 30, 2021. we surveyed the cards of all patients having a diagnosis of bronchopleural fistula for the last 10 years. The document was reviewed using an extraction checklist. Descriptive statistics (mean, standard deviation, frequency, percentages) and crosstabulation were used to describe the outcome variable.
A total of 52(2%) patients were diagnosed to have bronchopleural fistula out of 2546 patients admitted to the cardiothoracic unit in three hospitals from September 2012 - August 2021 and 69% of study participants were male. The mean age of study participants was 33.42 years with SD = 12.5. Thirty-one (60%) of the cases spontaneously developed a bronchopleural fistula and 20 (38%) were post-surgical and 1(2%) was a post-traumatic fistula. Of the total of post-surgical bronchopleural fistula, 14 (26.9%) of them were lung resection, 4 (7.7%) were hydatid cystectomy and 1(1.9%) are decortications, and bullectomy respectively. of the total post-lung resection, 8 (57%) were pneumonectomies followed by 3 (21.5%) Lobectomy, 2 (14.5%) wedge resection and 1(7%) bilobectomy respectively. Fifty patients were managed surgically and two patients were managed conservatively. Bronchopleural fistula (BPF) was closed in 40 (85.4%) and there were two (3.9%) deaths, and the cause of death was sepsis secondary to pneumonia of the contralateral lung in one case.
Having thoracic surgery is a risk factor for the development of bronchopleural fistula. Management of bronchopleural fistula needs to be individualized.
Pulmonary arteriovenous malformation is characterized by an anatomic right-to-left shunt between the pulmonary arteries and veins, is characterized by an anatomic right-to-left shunt which reduces ...the arterial oxygen saturation and then results in clinical manifestations such as dyspnea and cyanosis. Most cases are congenital, and although uncommon, they are a significant part of the differential diagnosis of pulmonary problems like hypoxemia and lung nodules.
We present a case of a 60 years old female patient who presented with the complaint of exacerbation of dry cough of 1-month duration and was diagnosed with right pulmonary arteriovenous malformation and successfully treated with surgery.
The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.
A prospective study was conducted and data were ...collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients' 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.
A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26-6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22-9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14-1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p = 0.16) CONCLUSION: In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
Echinococcosis is a re-emerging public health issue in developing countries as most communities are homes to dogs and other domesticated animals while cattle raising is a major habit of most ...sub-Saharan countries. The usual presentations include liver and lung cysts. While few documentations and publications have been made on extra-pulmonary intrathoracic hydatid cysts in other parts of the world, there has been no published document on extra-pulmonary intrathoracic hydatid cysts consisting of eighty or more cystic masses in a single patient in Ethiopia. We present a case of right sided extra-pulmonary intrathoracic hydatid cysts in a 20-year old Ethiopian male patient with compressive respiratory symptoms and significant social history of cohabiting with dogs throughout childhood. The patient was treated by surgery via a posterolateral thoracotomy and had a smooth Post-operative course and discharged home on postoperative day 15 on albendazole and analgesics. Intraoperative findings included approximately 1500 ml of cystic fluid, eighty cystic masses and collapsed lung.
•Echinococcosis is a re-emerging public health issue in developing countries.•Echinococcosis is among the most neglected tropical diseases.•Extrapulmonary hydatid cyst is rare entity and occurs in any part of thorax.•We present a case of right sided extrapulmonary hydatid cysts in a 20-year male.•We extracted eighty cystic masses intraoperatively, which is a rear discovery.
Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for ...collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research.
This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics.
A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center.
This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed.
Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening.
Chyle is tryglyceride reach fluid absorbed from the intestines. A total of 1500 ml–2400 ml of chyle flows through thoracic duct per day.
A 15 years old boy accidentally hit himself with a stick while ...he was playing with a rope attached to the stick. He was hit on the left side of anterior neck in zone one territory. He came seven days after the trauma when he experienced a progressively worsening shortness of breath and a bulge at the trauma site that appears with each breath. On exams, he had features of respiratory distress. The trachea was significantly shifted to the right side. There was dull percussion note on the entire left hemichest with decreased air entry. Chest x-ray showed massive left pleural collection with mediastinal shift to the right side. Chest tube was inserted and approximately 3,000 ml of milky fluid was evacuated. These continued for the following three days for which repeated thoracotomies were done for an attempt to obliterate the chyle fistula. The final successful surgery done was embolization of the thoracic duct with blood coupled with total parietal pleurectomy. After staying for approximately one month in the hospital, the patient was safely discharged improved.
Chylothorax following blunt neck injury is very rare. Chylothorax with significant output leads to malnutrion, immunocompromization and high rate of mortality without timely intervention.
Early therapeutic intervention is the core for good patient outcome. Decreasing thoracic duct output, adequate drainage, nutritional support, lung expansion and surgical intervention are the pillars of chylothorax management. The surgical options of thoracic duct injury are mass ligation, thoracic duct ligation, pleurodesis and pleuroperitoneal shunt. Intraoperative thoracic duct embolization with blood, as we have used in our patient, needs further study.
•Chylothorax is a debilitating condition associated with malnutrition and immunocompromization.•Blunt neck trauma is a rare cause of chylothorax•Where conservative management is suboptimal, surgical management must be decided early
Penetrating cardiac injury is rare (0.1 % of trauma admissions) but fatal. Presentation is with features of cardiac tamponade or hemorrhagic shock. Urgent clinical evaluation, ultrasound, temporizing ...pericardiocentesis or surgical repair with cardiopulmonary bypass as back up consist of standard management. In this paper, experience of management of penetrating cardiac injury from a resource limited country is presented.
There were seven patients, five had a stab injury and two had gunshot wound. All were men with mean age of 31.1 years. Patients arrived within 30 min (3), 2 h (2), 4 h (1) and 18 h (1) after injury. Mean initial blood pressure and pulse rates were 83/51 mm Hg and 121, respectively. One patient had pericardiocentesis before referral. Exploration was via left anterolateral thoracotomy. Four (57.1 %) had right ventricle perforation, one had both right and left ventricle, and two (28.5 %) had left ventricle perforation. Suture repair (6) and pericardial patch (1) were done without bypass machine as back up. Mean duration of stay in the intensive care unit and in the surgical wards were 4.4 days (range: 2–15) and 10.8 days (range: 1–48), respectively. All were discharged improved.
Penetrating cardiac injury presents with low blood pressure and tachycardia after stab or gunshot wounds. Right ventricle is mostly affected. Pericardiocentesis can be done as temporary measure. While having bypass machine as back up is recommended, the absence of it should not preclude intervention. Suture repair can be done with left anterolateral thoracotomy.
Penetrating cardiac injury can be managed in resource limited settings without back up of cardiopulmonary bypass. Early identification and surgical intervention results in favorable outcome.
•Trauma is leading cause of morbidity and mortality in adolescents and young adults.•Penetrating cardiac injury is rare, but fatal trauma.•Cardiac injury can be easily missed, especially in polytrauma patient.•Patients with penetrating cardiac injury should be evaluated and managed urgently.•Most patients can be managed with thoracotomy even in the absence of a back up cardiopulmonary bypass machine.
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