Motorcycle-related injuries at a university teaching hospital in north central Nigeria

Background:

Motorcycle-related injuries lead to considerable morbidity and mortality. The aim of this study is to determine the pattern and outcome of motorcycle-related injuries at Benue State University Teaching Hospital, Makurdi, Nigeria.

Patients and Methods:

Case records of all patients who presented to the accident and emergency department with motorcycle-related injuries between July 2012 and June 2013 were analysed for age, gender, injury host status (i.e. rider, pillion or pedestrian), nature of collision (motorcycle versus other vehicles, motorcycle versus motorcycle, motorcycle versus pedestrian or lone riders), body region injured, injury severity score (ISS) at arrival, length of hospital stay (LOS) and mortality.

Results:

Seventy - nine patients with motorcycle-related injuries were included in the study. They consisted of 63 males (61.8%) and 16 females (15.7%). The age range was 5-65 years with a mean of 32.4 ± 14.0. Motorcycle versus vehicle collisions were the most common mechanism of injury (n = 46, 58.2%). Musculoskeletal injuries constituted the most common injuries sustained (n = 50, 47.6%) and the tibia was the most frequently fractured bone (n = 14, 35.9%). The majority of patients (57.0%) sustained mild/moderate injuries (ISS ≤ 15). There was no statistically significant difference between the sexes for sustaining mild/moderate injuries or severe/profound injuries (P > 0.05). Mortality rate was 6.3% with head injuries being involved in all cases.

Conclusion:

Young males were mostly injured in motorcycle-related trauma. Musculoskeletal injuries were the most common injuries sustained and head injuries were involved in all the deaths. Enforcement of motorcycle crash bars and helmet usage is recommended.     

Two‐dimensional quantitative coronary angiographic models for bifurcation segmental analysis

Background : Quantitative coronary angiography (QCA) analysis for bifurcation lesions needs to be standardized. Objectives : In vitro validation of two models for bifurcation QCA segmental analysis. Methods : In the latest edition of the Cardiovascular angiography analysis system (CAAS 5v8, Pie Medical Imaging, Maastricht, The Netherlands) a 6‐segment model for two‐dimensional coronary bifurcation analysis was implemented next to the currently available 11‐segment model. Both models were validated against 6 precision manufactured plexiglas phantoms, each of them mimicking a vessel with three successive bifurcation lesions with variable anatomy and Medina class. The phantoms were filled with 100% contrast agent and imaged with a biplane gantry. Images acquired in antero‐posterior (AP) direction by either C‐arm and at 30° right and left anterior oblique angulation were analyzed by two independent analysts, blinded to the actual dimensions. Manual correction of the contours was not allowed. Measurements for minimal lumen diameter (MLD), reference vessel diameter (RVD), percent diameter stenosis (DS) and bifurcation angle (BA) were compared with the true phantom dimensions. Results : In AP views the accuracy and precision (mean difference ± SD) of 11‐ and 6‐segment model for MLD, RVD, and DS were 0.065 ± 0.128 mm vs. 0.058 ± 0.142 mm, ?0.021 ± 0.032 mm vs. ?0.022 ± 0.030 mm, and ?2.45% ± 5.07% vs. ?2.28% ± 5.29%, respectively. Phantom MLD values ≤0.7 mm were systematically overestimated; if excluded, MLD accuracy and precision became 0.015 ± 0.106 mm and 0.004 ± 0.125 mm for the 11‐ and 6‐segment model, respectively. Accuracy and precision for BA were ?2.2° ± 3.3°. Interobserver variability for MLD, RVD, DS, and BA for either model was ≤0.049 mm, ≤0.056 mm, ≤2.77%, and 1.6°, respectively. Agreement between models for MLD, RVD, and DS was ±0.079 mm, ±0.011 mm, and ±2.07%. Accuracy and precision for diameter‐derived parameters were slightly decreased in angulated projections; precision for BA measurements dropped to 6.1°. Conclusions : The results of both models are highly reproducible and for phantom MLD values >0.7mm in excellent agreement with the true dimensions. © 2011 Wiley‐Liss, Inc.     

OCT-measured plaque free wall angle is indicative for plaque burden: overcoming the main limitation of OCT?

The aim of this study was to investigate the relationship between the plaque free wall (PFW) measured by optical coherence tomography (OCT) and the plaque burden (PB) measured by intravascular ultrasound (IVUS). We hypothesize that measurement of the PFW could help to estimate the PB, thereby overcoming the limited ability of OCT to visualize the external elastic membrane in the presence of plaque. This could enable selection of the optimal stent-landing zone by OCT, which is traditionally defined by IVUS as a region with a PB?<?40?%. PB (IVUS) and PFW angle (OCT and IVUS) were measured in 18 matched IVUS and OCT pullbacks acquired in the same coronary artery. We determined the relationship between OCT measured PFW (PFW_OCT) and IVUS PB (PB_IVUS) by non-linear regression analysis. An ROC-curve analysis was used to determine the optimal cut-off value of PFW angle for the detection of PB?<?40?%. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. There is a significant correlation between PFW_OCT and PB_IVUS (r²?=?0.59). The optimal cut-off value of the PFW_OCT for the prediction of a PB_IVUS?<?40?% is ≥220° with a PPV of 78?% and an NPV of 84?%. This study shows that PFW_OCT can be considered as a surrogate marker for PB_IVUS, which is currently a common criterion to select an optimal stent-landing zone.     

Review article: Safety aspects of anesthesia in under-resourced locations

Purpose

Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world.

Principal findings

There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization’s Surgical Safety Checklist could further reduce morbidity and mortality.

Conclusions

Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.     

Combining variant detection and fragment length analysis improves detection of minimal residual disease in postsurgery circulating tumour DNA of stage II–IIIA NSCLC patients

Stage II–IIIA nonsmall cell lung cancer (NSCLC) patients receive adjuvant chemotherapy after surgery as standard‐of‐care treatment, even though only approximately 5.8% of patients will benefit. Identifying patients with minimal residual disease (MRD) after surgery using tissue‐informed testing of postoperative plasma circulating cell‐free tumour DNA (ctDNA) may allow adjuvant therapy to be withheld from patients without MRD. However, the detection of MRD in the postoperative setting is challenging, and more sensitive methods are urgently needed. We developed a method that combines variant calling and a novel ctDNA fragment length analysis using hybrid capture sequencing data. Among 36 stage II–IIIA NSCLC patients, this method distinguished patients with and without recurrence of disease in a 20 times repeated 10‐fold cross validation with 75% accuracy (P = 0.0029). In contrast, using only variant calling or only fragment length analysis, no signification distinction between patients was shown (P = 0.24 and P = 0.074 respectively). In addition, a variant‐level fragmentation score was developed that was able to classify variants detected in plasma cfDNA into tumour‐derived or white‐blood‐cell‐derived variants with 84% accuracy. The findings in this study may help drive the integration of various types of information from the same data, eventually leading to cheaper and more sensitive techniques to be used in this challenging clinical setting.     

The role of shear stress in the generation of rupture-prone vulnerable plaques

Blood-flow-induced shear stress acting on the arterial wall is of paramount importance in vascular biology. Endothelial cells sense shear stress and largely control its value in a feedback-control loop by adapting the arterial dimensions to blood flow. Nevertheless, to allow for variations in arterial geometry, such as bifurcations, shear stress control is modified at certain eccentrically located sites to let it remain at near-zero levels. In the presence of risk factors for atherosclerosis, low shear stress contributes to local endothelial dysfunction and eccentric plaque build up, but normal-to-high shear stress is atheroprotective. Initially, lumen narrowing is prevented by outward vessel remodeling. Maintenance of a normal lumen and, by consequence, a normal shear stress distribution, however, prolongs local unfavorable low shear stress conditions and aggravates eccentric plaque growth. While undergoing such growth, eccentric plaques at preserved lumen locations experience increased tensile stress at their shoulders making them prone to fissuring and thrombosis. Consequent loss of the plaque-free wall by coverage with thrombus and new tissue may bring shear-stress-controlled lumen preservation to an end. This change causes shear stress to increase, which as a new condition may transform the lesion into a rupture-prone vulnerable plaque. We present a discussion of the role of shear stress, in setting the stage for the generation of rupture-prone, vulnerable plaques, and how this may be prevented.