Paediatric trauma education in low- and middle-income countries: A systematic literature review

Background

Trauma-specific training improves clinician comfort and reduces patient morbidity and mortality; however, curricular content, especially with regard to paediatric trauma, varies greatly by region and income status. We sought to understand how much paediatric education is included in trauma curricula taught in low- and middle-income countries (LMICs).

Methods

We conducted a systematic literature review in October 2020 and in July 2022 based on PRISMA guidelines, utilizing seven databases: MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Reviews, Cochrane Trials, and Global Index Medicus. Reports were limited to those from World Bank-designated LMICs. Key information reviewed included use of a trauma curriculum, patient-related outcomes, and provider/participant outcomes.

Results

The search yielded 2008 reports, with 987 included for initial screening. Thirty-nine of these were selected for review based on inclusion criteria. Sixteen unique trauma curricula used in LMICs were identified, with only two being specific to paediatric trauma. Seven of the adult-focused trauma programmes included sections on paediatric trauma. Curricular content varied significantly in educational topics and skills assessed. Among the 39 included curricula, 33 were evaluated based on provider-based outcomes and six on patient-based outcomes. All provider-based outcome reports showed increased knowledge acquisition and comfort. Four of the five patient-based outcome reports showed reduction in trauma-related morbidity and mortality.

Conclusion

Trauma curricula in LMICs positively impact provider knowledge and may decrease trauma-related morbidity and mortality; however, there is significant variability in existing trauma curricula regarding to paediatric-specific content. Trauma education in LMICs should expand paediatric-specific education, as this population appears to be underserved by most existing curricula.

Anemochory of diapausing stages of microinvertebrates in North American drylands

1. Dry, ephemeral, desert wetlands are major sources of windblown sediment, as well as repositories for diapausing stages (propagules) of aquatic invertebrates. Zooplankton propagules are of the same size range as sand and dust grains. They can be deflated and transported in windstorm events. This study provides the evidence that dust storms aid in dispersal of microinvertebrate propagules via anemochory (aeolian transport). 2. We monitored 91 windstorms at six sites in the southwestern U.S. over a 17-year period. The primary study site was located in El Paso, Texas in the northern Chihuahuan Desert. Additional samples were collected from the Southern High Plains region. Dust carried by these events was collected and rehydrated to hatch viable propagules transported with it. 3. Using samples collected over a six-year period, 21 m above the ground which included 59 storm events, we tested the hypothesis that transport of propagules is correlated with storm intensity by monitoring meteorological conditions such as storm duration, wind direction, wind speed, and PM₁₀ (fine dust concentration). An air quality monitoring site located adjacent to the dust samplers provided quantitative hourly measurements. 4. Rehydration results from all events showed that ciliates were found in 92% of the samples, rotifers in 81%, branchiopods in 29%, ostracods in 4%, nematodes in 13%, gastrotrichs in 16%, and tardigrades in 3%. Overall, four bdelloid and 11 monogonont rotifer species were identified from rehydrated windblown dust samples. 5. PCA results indicated gastrotrichs, branchiopods, nematodes, tardigrades, and monogonont rotifer occurrence positively correlated with PM₁₀ and dust event duration. Bdelloid rotifers were correlated with amount of sediment deposited. NMDS showed a significant relationship between PM₁₀ and occurrence of some taxa. Zero-inflated, general linear models with mixed-effects indicated significant relationships with bdelloid and nematode transport and PM₁₀. 6. Thus, windstorms with high particulate matter concentration and long duration are more likely to transport microinvertebrate diapausing stages in drylands.

Towards a consensus on a hearing preservation classification system

CONCLUSION

The comprehensive Hearing Preservation classification system presented in this paper is suitable for use for all cochlear implant users with measurable pre-operative residual hearing. If adopted as a universal reporting standard, as it was designed to be, it should prove highly beneficial by enabling future studies to quickly and easily compare the results of previous studies and meta-analyze their data.

OBJECTIVES

To develop a comprehensive Hearing Preservation classification system suitable for use for all cochlear implant users with measurable pre-operative residual hearing.

METHODS

The HEARRING group discussed and reviewed a number of different propositions of a HP classification systems and reviewed critical appraisals to develop a qualitative system in accordance with the prerequisites.

RESULTS

The Hearing Preservation Classification System proposed herein fulfills the following necessary criteria: 1) classification is independent from users' initial hearing, 2) it is appropriate for all cochlear implant users with measurable pre-operative residual hearing, 3) it covers the whole range of pure tone average from 0 to 120 dB; 4) it is easy to use and easy to understand.

Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases

In this report we analyse the presenting features of a series of patients diagnosed with Waldenström macroglobulinaemia (WM) in Spain over the last 10 years. Criteria for diagnosis required a serum monoclonal IgM protein > or = 30 g/l and > 20% bone marrow lymphocytes. Two hundred and seventeen patients were included in the study, with a median age of 69 years and male/female ratio of 2:1. The most common symptoms at diagnosis were anaemia (38%), hyperviscosity (31%), B symptoms (23%), bleeding (23%) and neurological symptoms (22%). Sixty-one patients (27%) were asymptomatic at diagnosis and, to date, 32 of them have not received chemotherapy. Variables predicting a shorter survival free of therapy were haemoglobin < 12.5 g/dl and high beta2microglobulin (beta2M). The 83% of patients who did receive treatment were distributed as follows: chlorambucil/prednisone (43%), intermittent chlorambucil (11%), continuous chlorambucil (26%), cyclophosphamide/vincristine/prednisone (COP, 13.5%) and other (6.5%). Response to therapy was complete in 2%, partial in 48% and minor in 10%. Finally, 28% and 13% of patients presented stable and progressive disease, respectively, which was more common among patients treated with COP. Progression-free survival was 43% at 5 years, with three independent predictors for shorter progression-free survival (PFS): COP treatment, age > 65 and B symptoms at diagnosis. The 10-year projected overall survival (OS) was 55%. The two most frequent causes of death were development of second malignancies (31%), or infections (19%). The two main variables predicting a poor OS were hyperviscosity and high beta2M. In summary, this study favours the use of chlorambucil-based therapy as the standard treatment for WM, and describes a subset of patients who should be considered as suffering a smouldering form and who therefore do not require treatment for a long period of time.

Combined vestibular neurectomy and endolymphatic sac shunt via the retrosigmoid approach in the treatment of Ménière's disease

The nature of surgical treatment for Ménière's disease has evolved from destructive to conservative in the interest of preserving hearing. We have performed a combined procedure that involves a vestibular neurectomy to control vertigo, which is followed by an endolymphatic sac shunt to control hydrops in 26 patients. Both procedures are performed via the retrosigmoid approach during the same surgical step. We believe this combination procedure is a worthwhile option to consider in order to achieve good control of vertigo and endolymphatic hydrops and to preserve hearing in patients with Ménière's disease.

[Hemangioma of the spermatic cord. Presentation of a case with review of the literature]

OBJECTIVE

To describe a rare variety of spermatic cord tumor, with special reference to the differential diagnosis. The literature is briefly reviewed.

METHODS

The clinical and pathological features of a tumor located in the right inguino-scrotal region of a 27-year-old male patient are described.

RESULTS

The preoperative evaluation disclosed an irregular mass in the right hemiscrotum that was unconnected to the testis. The patient underwent orchidectomy and resection of the tumor. Pathological analysis of the surgical specimen revealed a hemangioma of the spermatic cord.

CONCLUSIONS

Hemangioma of the spermatic cord is a very uncommon tumor, it is a slow growing, indolent, benign scrotal lesion that must be distinguished from other paratesticular masses or tumors with similar clinical features. Ultrasound and other diagnostic imaging techniques are not useful in making the preoperative differential diagnosis.

Surgical treatment of Menière's disease

Surgical treatment is used only for patients with Menière's disease in cases that do not respond to medical therapy. At the present time, the endolymphatic sac shunt operation is performed in cases where the auditory threshold is fluctuant around 30 dB. When the auditory threshold is between 40 and 70 dB we use the vestibular neurectomy by the retrosigmoid approach. In patients with Menière's disease with profound hearing loss the translabyrinthine neurectomy is used. The advantages of the vestibular neurectomy by the retrosigmoid approach compared to the retrolabyrinthine and middle fossa approaches will be described.

[Blind bifid ureter associated with duplicity and contralateral vesicoureteral reflux]

We report on a pediatric patient who was evaluated for recurrent episodes of urinary tract infection. Evaluation by IVP, cystography and retrograde ureteropyelography revealed a complete ureteral duplicity, grade II vesicoureteral reflux in the lower half of the left kidney and a blind bifid ureter arising at the distal third of the right ureter. This is an uncommon condition (about 150 cases have been reported) difficult to diagnose if undetected by conventional radiological evaluation and retrograde ureteropyelography may be required. It may be associated with urological or other types of malformations. It is generally asymptomatic and with scant consequences, thus treatment is initially conservative. Surgical excision of the blind bifid ureter is warranted only when complications present. In the present case, prophylactic antibiotic therapy was instituted. At one year follow up, the patient is asymptomatic and urine cultures are negative.

[A program of intracavernous drug-induced erection for the treatment of impotence]

The study includes 138 patients with erectile dysfunction, all of them previously treated with intracavernous injections. Following study and classification of the type of impotence, they were all included in one of the four following groups. The drugs used were, in group I (73 patients) Prostaglandins E1, in group II (37 patients) Papaverine, in group III (6 patients) a combination of Papaverine and Phentolamine and in group IV (22 patients) a combination of Papaverine and Prostaglandins E1. We found a good treatment response in 59.3% cases (60.3% in group I, 51.3% in group II, 66.7% in group III, and 69% in group IV). We outline the better results obtained in group IV, as well as the reduced number of complications in our series.

[Infiltrating transitional carcinoma of the bladder (4). Our approach to stage pT2 and critique of other risk factors. Multifactorial analysis]

From the analysis of our experience with pT2 and pT3a tumours it could be deduced that the former have better prognosis. The papillary appearance, invasion in a wide front and extent, whether with good or moderate differentiation, in T2 are signs of good prognosis, as well as the non-existence of unilateral dilation or an effaced kidney. Considering the good evolution obtained with radical cystectomy only, these patients should be recruited for study in order to see whether evolution with bladder preservation is similar. Patients with pT2 tumours should not be included in protocols to evaluate the efficacy of adjuvant therapies used with surgery. The evolution is not equivalent to that expected in tumours of deeper invasion.