Clinical Knowledge and Practice of "Ketofol" at University of Gondar Comprehensive Specialized Hospital

Assessment of the predictive factors and outcomes of surgically treated patients with depressed skull fracture at a tertiary hospital, Northwest Ethiopia

INTRODUCTION

Depressed skull fractures occur when a portion of the skull is displaced inward towards the brain, leading to complications such as intracranial hematoma, brain contusion, and intracranial infection. Managing these fractures necessitates a multidisciplinary approach, with postoperative management and rehabilitation playing crucial roles in optimizing patient outcomes. This study aimed to assess the predictive factors and outcomes of patients who underwent surgical treatment for depressed skull fractures.

METHOD

A comprehensive retrospective review was undertaken on the medical records of all patients who underwent surgery for depressed skull fractures at the University Comprehensive Specialized Hospital from January 1, 2021, to January 1, 2023 G.C. Patients with missile injuries were excluded from this study. The analysis incorporated a total of 163 patients.

RESULTS

A total of 163 patients (mean age 23.9; standard deviation 14.8; range 3-65) were studied, comprising 136 men (83.4%) and 27 women (16.6%). Among them, 153 (93.9%) were under 50 years old. Physical assault accounted for 102 (62.5%) of the injuries, with 62 (38%) involving a stone, 32 (19.6%) a stick, and 8 (5%) other objects (e.g., shovel, beer bottle). Using the Glasgow Coma Scale (GCS), minor head injuries were found in 123 individuals (75%). Fracture sites predominantly included frontal depressions (61 patients, 37.4%) and parietal depressions (53 patients, 32.5%). The associated injuries featured brain contusion (52 cases, 32%), epidural hematoma (26 cases, 16%), subdural hematoma (3 cases, 1.8%), and IVH/SAH (3 cases, 1.8%). Following surgery, full recovery occurred in 148 patients (91%), while sequelae-such as hemiparesis and aphasia-affected 15 patients (9%); unfortunately, three patients (1.8%) died due to critical head injuries prior to admission. Complications included meningitis (4 cases, 2.55%), brain abscesses (2 cases, 1.2%), surgical site infections (10 cases, 6.1%), hypocalcemia in one patient, post-traumatic stress disorder in two patients(1.6%), and osteomyelitis of the skull bone in two patients(1.2%). The multivariable logistic regression revealed that low GCS scores, compound fractures, hemiparesis, and the presence of an epidural hematoma were found to be substantially associated with a poorer outcome.

CONCLUSION

The overall outcome of patients with depressed skull fracture was favorable. Factors associated with worse outcomes include compound fracture, low Glasgow Coma Scale at admission, presence of weakness, and presence of epidural hematoma. Complications associated with depressed skull fractures observed in our patients include wound infection, meningitis, brain abscess, osteomyelitis, PTSD, and hypocalcemia.

Surgical outcome of pediatric abdominal trauma at Tertiary Hospital, Northwest Ethiopia, a 3-year retrospective study

INTRODUCTION

Abdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts.

METHOD

A retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient's medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected.

RESULTS

The study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10.

CONCLUSION

Following abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons.

Assessment of Surgical Treatment and Outcome of Chronic Subdural Hematoma at University of Gondar Comprehensive Specialized Hospital, a one Year Prospective Study

OBJECTIVE

Chronic subdural hematomas (CSDHs) are a relatively common condition defined as an abnormal collection of blood and its break down products in the subdural space, usually accompanied by a history of preceding mild head trauma. Surgical management remains the mainstay of treatment. The objective of this study was to assess the surgical treatment outcome of patients operated on for CSDH at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. This comprehensive novel study serves as a benchmark for assessing therapeutic outcomes among patients with CSDH in the context of Ethiopia.

METHODS

Institution-based prospective observational study was conducted among patients operated on for symptomatic CSDH at University of Gondar Comprehensive Specialized Hospital from January 1, 2023, to December 31, 2023 G C.

RESULT

A total of 107 patients (70 males (65.4%) and 37 females (34.6%) with a male to female ration of 1.9:1 and mean age of 62.4 and a standard deviation of 13.7 (range from 23 to 92) were studied. Fifyt-one (47.7%) of the patients had a history of antecedent trauma. In terms of clinical symptoms, 86 (80.4%) patients had weakness as the chief complaint, followed by headache in 81 (75.7%). Among complications, recurrence is the most common, which was seen in 16 (15%) patients, followed by altered mental status (confusion, delirium) in 18 (16.8%) patients. The mean duration of the hospital stay was 6 days, with a standard deviation of 4 days. The majority of the patients had a good recovery with the resumption of normal life: 92 (86%), 10 (9.3%) patients had moderate disability, were disabled but independent, 2 (1.8%) patients had severe disability, were dependent on daily support, and 3 (2.8%) patients died.

CONCLUSION

CSDHs are a relatively common condition characterized by an abnormal collection of blood. Antecedent trauma is the usual risk factor. Complication can happen following surgical intervention; however, patients with CSDH generally have a good prognosis.

Magnitude of dural tear and its associated factors among patients with depressed skull fracture

INTRODUCTION

Trauma is a huge problem seen in developed countries as well as developing countries. Head injury is a major factor responsible for mortality in young populations. Up to 6% of all head injuries and 11% of severe head traumas might result in a depressed skull fracture (DSF), a catastrophic injury. The aim of this study was to determine the prevalence of dural tear and to identify its predictors.

METHOD

A retrospective review of medical records of all patients operated on for DSFs at the University Comprehensive Specialized Hospital from 1 January 2021 to 1 January 2023 G.C. (Gregorian calendar) was conducted. A total of 163 patients were included in the study.

RESULTS

A total of 163 patients [136 men (83.4%) and 27 women (16.6%)] had a mean age of 23.9 with a standard deviation of 14.8 (range from 3 to 65). Patients with penetrating injuries (missiles, axes) were excluded. The majority, 153 (93.9%) of the patients, were younger than 50 years of age. Physical assault accounted for 102 (62.5%) of the cases. Of the assaulted cases, 62 (38%) were assaulted by stone, 32 (19.6%) by stick, and 8 (5%) by other objects (beer bottle and shovel). Bleeding from the trauma site in 124 (76.1%), headache in 76 (46.6%), loss of consciousness in 75 (46%), and vomiting in 72 (44.2%) were the most common presentations. Based on the Glasgow Coma Scale (GCS), 123 (75%) patients had mild head injuries. Based on the site of fracture, frontal depressions are the most common (61, 37.4%), followed by parietal depressions (53, 32.5%). With regard to the associated injuries, brain contusion was seen in 52 (32%), epidural hematoma (EDH) in 26 (16%), subdural hematoma in 3 (1.8%), and intraventricular hemorrhage/subarachnoid hemorrhage (IVH/SAH) in 3 (1.8%). The median duration of presentation was 15 h, with an interquartile range (IQR) of 8-24 (1-96 h). From the multivariable logistic regression, brain contusion and EDH were significantly associated with dural tear.

CONCLUSION

The rules of our culture are reflected in the higher incidence of accidents and fractures among men. Physical assault, particularly with stones, was the most common cause of DSFs. Frontal depressions were the most common site of fracture, followed by parietal fractures. Brain contusion and EDH were significantly associated with dural tears. School-aged children are more vulnerable to injuries from horse or donkey kicks and falls.

The magnitude and associated factors of coagulation abnormalities among liver disease patients at the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2022

BACKGROUND

Liver disease is any condition that affects the liver cells and their function. It is directly linked to coagulation disorders since most coagulation factors are produced by the liver. Therefore, this study aimed to assess the magnitude and associated factors of coagulation abnormalities among liver disease patients.

METHODS

A cross-sectional study was conducted from August to October 2022 among 307 consecutively selected study participants at the University of Gondar Comprehensive Specialized Hospital. Sociodemographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 2.7 mL of venous blood were collected and analyzed by the Genrui CA51 coagulation analyzer. Data were entered into Epi-data and exported to STATA version 14 software for analysis. The finding was described in terms of frequencies and proportions. Factors associated with coagulation abnormalities were analyzed by bivariable and multivariable logistic regression.

RESULT

In this study, a total of 307 study participants were included. Of them the magnitude of prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) were 68.08% and 63.51%, respectively. The presence of anaemia (AOR = 2.97, 95% CI: 1.26, 7.03), a lack of a vegetable feeding habit (AOR = 2.98, 95% CI: 1.42, 6.24), no history of blood transfusion (AOR = 3.72, 95% CI: 1.78, 7.78), and lack of physical exercise (AOR = 3.23, 95% CI: 1.60, 6.52) were significantly associated with prolonged PT. While the presence of anaemia (AOR = 3.02; 95% CI: 1.34, 6.76), lack of vegetable feeding habit (AOR = 2.64; 95% CI: 1.34, 5.20), no history of blood transfusion (AOR = 2.28; 95% CI: 1.09, 4.79), and a lack of physical exercise (AOR = 2.35; 95% CI: 1.16, 4.78) were significantly associated with abnormal APTT.

CONCLUSION

Patients with liver disease had substantial coagulation problems. Being anemic, having a transfusion history, lack of physical activity, and lack of vegetables showed significant association with coagulopathy. Therefore, early detection and management of coagulation abnormalities in liver disease patients are critical.