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Mwesige S, Ndossi M, Rutabasibwa N, Lemeri L. Penetrating head trauma resulting from vigilante street justice. Surg Neurol Int 2024; 15:92. [PMID: 38628506 PMCID: PMC11021100 DOI: 10.25259/sni_1031_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background Penetrating brain injury (PBI) can be caused by a variety of objects ranging from simple to complicated items. Nonetheless, it is strange and unusual to attack someone in the head with a long nail. Due to its rarity, care for them is still being developed and may include many steps. Case Description We are presenting a 35-year-old guy who was neurologically intact and hemodynamically stable but complained of headaches following a nail blow into the skull during a domestic altercation by a gang of individuals. A computed tomography scan revealed the metallic item inside the brain parenchyma. The patient recovered well from the procedure, which included the early removal of the foreign body, evacuation of the hematoma, and dura repair. Our objective is to demonstrate a few broad management concepts that help enhance patient outcomes. We covered the clinical manifestation and effective treatment of such a rare injury in this study. Conclusion Proper handling and rapid transport of patients to the advanced trauma center are crucial for victims of PBI. Timely and skilled interventions could prevent further nervous tissue damage and any related neurological dysfunction.
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Affiliation(s)
- Sylvery Mwesige
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maxigama Ndossi
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | | | - Laurent Lemeri
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
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Pickering AE, Malherbe P, Nambuba J, Bills CB, Hynes EC, Rice B. Clinical emergency care quality indicators in Africa: a scoping review and data summary. BMJ Open 2023; 13:e069494. [PMID: 37130667 PMCID: PMC10163454 DOI: 10.1136/bmjopen-2022-069494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Emergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators. DESIGN We conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature. DATA SOURCES PubMed (1964-2 January 2022), Embase (1947-2 January 2022) and CINAHL (1982-3 January 2022) and various forms of grey literature were queried. ELIGIBILITY CRITERIA Studies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as 'AFEM-CC quality indicators near match'. DATA EXTRACTION AND SYNTHESIS Document screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated. RESULTS One thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 'AFEM-CC quality indicators near match' publications were identified (38 new publications and 15 previously identified studies that contained additional 'near match' data), yielding 87 data points. CONCLUSIONS Data relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
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Affiliation(s)
- Ashley E Pickering
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Petrus Malherbe
- Emergency Medicine, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Joan Nambuba
- Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Corey B Bills
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie Calvello Hynes
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Brian Rice
- Emergency Medicine, Stanford University, Palo Alto, California, USA
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. BRAIN & SPINE 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Buh FC, Taiwe GS, Maas AI, Motah M, Youm E, Wanyu BY, Wang KW, Hutchinson PJ, Sumbele IUN. Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study. Neurotrauma Rep 2022; 3:569-583. [PMID: 36711440 PMCID: PMC9879018 DOI: 10.1089/neur.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Traumatic brain injury (TBI) is a huge public health challenge worldwide. Epidemiological monitoring is important to inform healthcare policy. We aimed at determining the prevalence, outcome, and causes of TBI in Cameroon by conducting a 5-year retrospective study in three referral trauma centers. Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were recorded. Comparisons between two categorical variables were done using Pearson's chi-square test or Fisher's exact test. A total of 6248 cases of TBI were identified of 18,151 trauma cases, yielding a prevalence of 34%. The number of TBI cases increased across the years (915 in 2016, 1406 in 2020). Demographic data and causes of TBI were available for 6248 subjects and detailed data on clinical characteristics on 2178 subjects. Median age was 30.0 (24.0, 41.0) years. Males were more affected (80%). Road traffic incidents (RTIs; 75%) was the main cause of TBI, with professional bike riders being more affected (17%). Computed tomography (CT) imaging was performed in 67.7% of cases. Of the 597 (27.4%) cases who did not undergo neuroimaging, 311 (52.1%) did not have neuroimaging performed because of financial constraints, among which 7% were severe TBI cases. A total of 341 (19.6%) patients were discharged against medical advice, of which 83% had financial limitations. Mortality was 10.3% (225 of 2178) in the overall population, but disproportionately high in patients with severe TBI (55%) compared to those in high-income settings (27%). TBI occurrence is high in Cameroon, and RTIs are the main causes. Disparities in care provision were identified as attributable to financial constraints regarding CT scanning and continuation of care. The data presented can inform preventive interventions to improve care provision and transport policies. Implementation of a universal health insurance may be expected to improve hospital care and reduce the adverse effects of TBI among Cameroonians.
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Affiliation(s)
- Franklin Chu Buh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea, Cameroon
- Panafrican Hospital Center-Douala, Buea, Cameroon
| | - Germain Sotoing Taiwe
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea, Cameroon
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Mathieu Motah
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Bertrand Yuwong Wanyu
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea, Cameroon
| | - Kevin W. Wang
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Peter J.A. Hutchinson
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Irene Ule Ngole Sumbele
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea, Cameroon
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Traumatic intracranial haemorrhage in Cameroon: Clinical features, treatment options and outcome. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Adegboyega G, Zolo Y, Sebopelo LA, Dalle DU, Dada OE, Mbangtang CB, Tetinou F, Kanmounye US, Alalade AF. The Burden of Traumatic Brain Injury in Sub-Saharan Africa: A Scoping Review. World Neurosurg 2021; 156:e192-e205. [PMID: 34520864 DOI: 10.1016/j.wneu.2021.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the growing incidence of traumatic brain injury (TBI) in Sub-Saharan Africa, there is yet to be a study to map the current burden of the disease on the continent. This scoping review aims to outline the literature on TBI. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. A search string was developed to identify studies relating to TBI epidemiology, management, and outcomes. The search was applied to Medline, Embase, and Global Medicus Index. RESULTS In total, 107 studies were included in the final analysis. More than one half originated from South Africa. Seventy-five studies were published in 2013 or later. Studies recruited a median of 115 patients: 83.5 male and 31 female. TBI affected all age groups (range = 0-105 years) and sexes but was more common among young males aged 20-40. Road traffic accidents caused TBI in a median of 71 patients. Other major causes included assault (median = 39.5) and falls (median = 12.5). Craniectomies were the most commonly reported surgical treatment (18.7%) followed by burr holes (7.5%). Four studies (3.7%) reported delays in seeking neurotrauma care, with delays in reaching a neurotrauma facility and delays in receiving care being reported in 15 studies (14%) each. Glasgow Outcome Scale score was reported in 28 (26.1%) studies, whereas quality of life measures were reported in 2 (1%). Younger age was associated with favorable outcomes. CONCLUSIONS There is an increased need for TBI research, education, and training in Sub-Saharan Africa. This will aid stakeholders in optimizing patient management and outcome.
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Affiliation(s)
- Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Francklin Tetinou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Staton CA, Vissoci JRN, Toomey N, Abdelgadir J, Chou P, Haglund M, Mmbaga BT, Mvungi M, Swahn M. The impact of alcohol among injury patients in Moshi, Tanzania: a nested case-crossover study. BMC Public Health 2018; 18:275. [PMID: 29466975 PMCID: PMC5822650 DOI: 10.1186/s12889-018-5144-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, alcohol is responsible for 3.3 million deaths annually and contributes to 5.9% of the overall global burden of disease. In Sub-Saharan Africa, alcohol is the leading avoidable risk factor accounting for a substantial portion of death and disability. This project aimed to determine the proportion of injuries related to alcohol and the increased risk of injury due to alcohol among injury patients seeking care at the emergency department (ED) of Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. METHODS A representative cross-sectional sample of adult patients presenting to the KCMC ED with acute injury were enrolled in this study with a nested case-crossover design. Patient demographics, injury characteristics, and severity as well as alcohol use behaviors were collected. Alcohol breathalyzers were administered to the enrolled patients. Data on activities and alcohol use were collected for the time period 6 h prior to injury and two control periods: 24-30 h prior to injury and 1 week prior to injury. RESULTS During 47 weeks of data collection, 24,070 patients were screened, of which 2164 suffered injuries, and 516 met the inclusion and exclusion criteria, consented to participate, and had complete data. Of the study participants, 76% were male, and 30% tested positive for alcohol on arrival to the ED. Alcohol use was associated with being male and being employed. Alcohol use was associated with an increased risk of injury (OR 5.71; 95% CI 3.84-8.50), and specifically road traffic injuries were associated with the highest odds of injury with alcohol use (OR 6.53, 95% CI 3.98-10.71). For all injuries and road traffic injuries specifically, we found an increase in the odds of injury with an incremental increase in the dose of alcohol. CONCLUSIONS At KCMC in Moshi, Tanzania, 3 of 10 injury patients tested positive for alcohol on presentation for care. Similarly, alcohol use conveys an increased risk for injury in this setting. Evidence-based prevention strategies for alcohol-related injuries need to be implemented to reduce alcohol misuse and alcohol-related injuries.
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Affiliation(s)
- Catherine A Staton
- Division of Emergency Medicine, Duke University Medical Center, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA. .,Duke Global Health Institute, Duke University, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA. .,Duke Global Neurosurgery and Neurology Division, Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Duke University Medical Center, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA.,Duke Global Neurosurgery and Neurology Division, Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA
| | - Jihad Abdelgadir
- Duke Global Health Institute, Duke University, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA
| | - Patricia Chou
- National Institute of Alcohol Abuse and Alcoholism, Washington, DC, USA
| | - Michael Haglund
- Duke Global Health Institute, Duke University, Box 3096, 2301 Erwin Road, Durham, North Carolina, USA.,Duke Global Neurosurgery and Neurology Division, Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | | | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Monica Swahn
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Ndoumbe A, Ngoyong Edu PB, Simeu C, Takongmo S. Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojmn.2018.81010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Staton CA, De Silva V, Krebs E, Andrade L, Rulisa S, Mallawaarachchi BC, Jin K, RicardoVissoci J, Østbye T. High road utilizers surveys compared to police data for road traffic crash hotspot localization in Rwanda and Sri Lanka. BMC Public Health 2016; 16:53. [PMID: 26792526 PMCID: PMC4719689 DOI: 10.1186/s12889-015-2609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/14/2015] [Indexed: 11/23/2022] Open
Abstract
Backgrond Road traffic crashes (RTCs) are a leading cause of death. In low and middle income countries (LMIC) data to conduct hotspot analyses and safety audits are usually incomplete, poor quality, and not computerized. Police data are often limited, but there are no alternative gold standards. This project evaluates high road utilizer surveys as an alternative to police data to identify RTC hotspots. Methods Retrospective police RTC data was compared to prospective data from high road utilizer surveys regarding dangerous road locations. Spatial analysis using geographic information systems was used to map dangerous locations and identify RTC hotspots. We assessed agreement (Cohen’s Kappa), sensitivity/specificity, and cost differences. Results In Rwanda police data identified 1866 RTC locations from 2589 records while surveys identified 1264 locations from 602 surveys. In Sri Lanka, police data identified 721 RTC locations from 752 records while survey data found 3000 locations from 300 surveys. There was high agreement (97 %, 83 %) and kappa (0.60, 0.60) for Rwanda and Sri Lanka respectively. Sensitivity and specificity are 92 % and 95 % for Rwanda and 74 % and 93 % for Sri Lanka. The cost per crash location identified was $2.88 for police and $2.75 for survey data in Rwanda and $2.75 for police and $1.21 for survey data in Sri Lanka. Conclusion Surveys to locate RTC hotspots have high sensitivity and specificity compared to police data. Therefore, surveys can be a viable, inexpensive, and rapid alternative to the use of police data in LMIC. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2609-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine A Staton
- Division of Emergency Medicine, Duke University Medicine Center, Durham, USA. .,Duke Global Health Institute, Durham, NC, USA.
| | - Vijitha De Silva
- Duke Global Health Institute, Durham, NC, USA. .,Department of Community Medicine; Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka.
| | - Elizabeth Krebs
- Division of Emergency Medicine, Duke University Medicine Center, Durham, USA.
| | - Luciano Andrade
- State University of West of Parana / Unioeste, Foz do Iguaçu, Brazil. .,Public Health Research Group, Unioeste, Toledo, Brazil.
| | - Stephen Rulisa
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda. .,University Teaching Hospital of Kigali, Kigali, Rwanda.
| | | | - Kezhi Jin
- Department of Occupational Health; School of Public Health, Fudan University, Shanghai, China.
| | - Joao RicardoVissoci
- Duke Global Health Institute, Durham, NC, USA. .,Faculty of Medicine, Faculdade de INGA, Maringa, Brazil.
| | - Truls Østbye
- Department of Community Medicine; Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka.
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Tran TM, Fuller AT, Kiryabwire J, Mukasa J, Muhumuza M, Ssenyojo H, Haglund MM. Distribution and Characteristics of Severe Traumatic Brain Injury at Mulago National Referral Hospital in Uganda. World Neurosurg 2015; 83:269-77. [DOI: 10.1016/j.wneu.2014.12.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
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