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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 10 | Issue 2
Page Nos. 45-104

Online since Monday, June 8, 2020

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EDITORIAL  

What's New in Critical Illness and Injury Science? Mental health and COVID-19: Self-inflicted and interpersonal violence amid a pandemic p. 45
Thomas J Papadimos
DOI:10.4103/IJCIIS.IJCIIS_66_20  
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EXPERT COMMENTARIES Top

The coronavirus disease-2019 pandemic, social distancing, and observance of religious holidays: Perspectives from Catholicism, Islam, Judaism, and Hinduism p. 49
Andrew C Miller, Alberto A Castro Bigalli, Phanniram Sumanam
DOI:10.4103/IJCIIS.IJCIIS_60_20  
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Novel coronavirus (COVID-19): N95 mask hysteria p. 53
Manish Garg, Sona M Garg
DOI:10.4103/IJCIIS.IJCIIS_78_20  
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CLINICAL MANAGEMENT GUIDELINE Top

Optimizing respiratory care in coronavirus disease-2019: A comprehensive, protocolized, evidence-based, algorithmic approach Highly accessed article p. 56
Sagar Sinha, Indrani Sardesai, Sagar C Galwankar, PW B. Nanayakkara, Dindigal Ramakrishnan Narasimhan, Joydeep Grover, Harry L Anderson III, Lorenzo Paladino, David F Gaieski, Salvatore Di Somma, Stanislaw P Stawicki
DOI:10.4103/IJCIIS.IJCIIS_69_20  
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ORIGINAL ARTICLES Top

Road traffic injuries in a Nigerian referral trauma center: Characteristics, correlates, and outcomes p. 64
Ndubuisi O Onyemaechi
DOI:10.4103/IJCIIS.IJCIIS_18_19  
Background: Globally, road traffic injuries (RTIs) are a leading cause of disability and trauma-related deaths. We aimed to describe the clinical and epidemiological characteristics and outcomes of RTIs in our environment to provide the evidence for effective control measures. Methods: This was a 1-year retrospective study of all patients with RTIs treated at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Results: Four hundred and twenty-one patients with 484 injuries were studied. The mean age of the patients was 34.4 ± 14.6 years, and the male-to-female ratio was 3.3:1. Most of the injuries occurred on intercity roads/highways (48.7%) and involved motorcycle crashes (31%). Soft-tissue injuries (27.7%) and fractures (21.9%) were the most common types of injuries. The lower extremities were the most common sites of injury. The mean injury-arrival interval was 23.2 ± 2.4 h. The injury severity score (ISS) ranged from 1 to 50, with a mean of 9.2 ± 2.9. The 1-year mortality rate was 10.7%. Traumatic brain injury, open vehicular injuries, and increased ISS were the potential risk factors for mortality. Conclusion: Soft-tissue injuries and fractures were the most common types of injuries. The majority of the injuries occurred on the inter-city roads and highways and involved head-on-collisions with motorcycles. The young male adults were the most commonly affected age group.
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Road traffic accidents in Bangladesh: Why people have poor knowledge and awareness about traffic rules? p. 70
Md Rafiqul Islam, Md Mostaured Ali Khan, Md Mosharaf Hossain, Kulanthayan K C. Mani, Ruhani Mat Min
DOI:10.4103/IJCIIS.IJCIIS_65_19  
Purpose: The study aimed to identify the characteristics of road traffic accident (RTA) and to determine the role of different socioeconomic and demographic factors on the knowledge and awareness about traffic rules among people in Bangladesh. Study Design: This was a cross-sectional study. Methods: To conduct this study, 700 primary data were collected from respondents who were involved in RTA by interviewing in medical college hospitals and several private clinics of Dhaka, Rajshahi, and Khulna division in Bangladesh. For the achievement of the objective, the Chi-square test, Cramer's V correlation, and the logistic regression model have been applied in this study. Results: Traffic rules violation was identified as the second-most important reason behind RTA. Respondent's age, gender, residence, education, occupation, awareness about RTA, etc., were significantly associated with having knowledge and awareness about traffic rules. The result of multivariate analysis showed that respondent's age (<30: odds ratio [OR] = 2.019, confidence interval [CI]: 1.377–2.960); residence (rural: OR = 0.288, CI: 0.193–0.431); education (literate: OR = 5.064, CI: 3.332–7.698); and categories of victims (driver: OR = 2.731, CI: 1.676–4.450 and passenger: 1.869, CI: 1.198–2.916) were the vital predictors of having knowledge and awareness about traffic rules. Conclusions: By imposing strict traffic act, increasing public awareness through various types of education and awareness/outreach about traffic rules-related program, especially in rural areas, by strictly prohibiting the license giving to unskilled drivers or unfit vehicles, RTA can be minimized.
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The age and gender distribution of patients admitted following nonfatal road traffic accidents in Riyadh: A cross-sectional study p. 76
Jobby Gorge, Lena Alsufyani, Ghezlan Almefreh, Shahad Aljuhani, Layla Almutairi, Ibrahim Al Babtain, Fatmah Othman
DOI:10.4103/IJCIIS.IJCIIS_16_19  
Introduction: Road traffic accidents (RTAs) are the leading cause of mortality and disability nationally and globally. There is a need to identify the age and gender distribution of individuals involved in nonfatal RTAs. Methods: This was a cross-section study using electronic trauma registry data from King Abdulaziz Medical City. We included all trauma registry patients older than 14 years, who were involved in a nonfatal RTA from 2015 to 2017. The data collected included patient demographic information (age and gender), injury mechanism, injury type, and severity. Results: In total, 1314 patients were included in the analysis. The majority of the sample (88%) was male, with a median age of 25 (interquartile range: 21–35) years. A higher proportion of the male group had severe injury scores. Gender was equally distributed in terms of head-and-neck injuries. The majority (66%) of the sample was admitted in a ward. The female group had a higher proportion (17%) of chest injuries. In terms of age, the 65-year and older group had more severe injuries to the head, neck, and chest. Conclusions: The findings of this study provide updated evidence regarding the age group most frequently involved in nonfatal RTAs. The evidence from this study supports the urgent need for developing prevention programs such as early awareness and education for young drivers and passengers of both genders.
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Variability of radiological grading of blunt cerebrovascular injuries in trauma patients p. 81
Aimee K LaRiccia, Timothy W Wolff, David J Magee, Roocha Patel, David W Hoenninger, M Shay Oxs'Mara, Urmil B Pandya, Joshua H Hill, Thanh V Nguyen, M Chance Spalding
DOI:10.4103/IJCIIS.IJCIIS_103_19  
Context: Blunt cerebrovascular injury (BCVI) occurs in 1%–2% of all blunt trauma patients. Computed tomographic angiography of the neck (CTAn) is commonly used for the diagnosis and grading of BCVIs. Grade of injury dictates treatment, and there remains a lack in understanding the inter-reader reliability of these interpretations. Aims: The aim of this study is to determine the extent of variability in BCVIs among specialized neuroradiologist interpretation of CTAn. Settings and Design: Retrospective review of trauma patients admitted to a level one trauma center with a BCVI from January 2012 to December 2017. Patients were randomly assigned for CTAn re-evaluation by two of three blinded, neuroradiologists. Statistical Analysis Used: The variability in BCVI grades was measured using the coefficient of unalikeability (u), and inter-reader reliability was calculated using weighted Cohen's kappa (k). Results: Two hundred and twenty-eight BCVIs were analyzed with initial grades of 71 (31%) grade one, 74 (32%) grade two, 26 (11%) grade three, 57 (25%) grade four, and 0 grade five. Variability was present in 93 (41%) of all BCVIs. Grade one injuries had the lowest occurrence of total agreement (31%) followed by grade three (61%), grade two (63%), and grade four (92%). Total variability of grade interpretations (u = 100) occurred most frequently with grade three BCVIs (21%). Weighted Cohen's k calculations had a mean of 0.07, indicating poor reader agreement. Conclusions: This novel study demonstrated the BCVI variability of radiological grade interpretation occurs in more than a third of patients. The reliability of CTAn interpretation of BCVI grades is not uniform, potentially leading to undertreatment and overtreatment.
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Suicides in China from 2008-2017: A longitudinal epidemological study p. 88
Huiting Yu, Chan Nie, Yanna Zhou, Xue Wang, Haiyan Wang, Xiuquan Shi
DOI:10.4103/IJCIIS.IJCIIS_108_19  
Introduction: We aimed to describe the change of suicide rates in China from 2008 to 2017 and provide suggestions for the prevention of suicide. Subjects and Methods: A longitudinal study included the time point tracking were used in our study. The suicide data in China were collected from the authoritative official website and yearbook of China from 2008 to 2017. Data were analyzed by SPSS (version 18.0, IBM Corp., Armonk, NY, USA). Origin (version 9.0) was used for graph. Results: We found that the suicide rate in China showed a downward trend. The suicide rate for males in rural was the highest, followed by rural women. Then urban male, and urban female suicide rate was the lowest. The difference was statistically significant (F = 88.35, P < 0.01). Conclusions: The suicide rate in rural areas was higher than that in cities, and men were higher than women. The government should focus on preventing high suicide rates in rural areas, especially men.
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Traumatic injuries associated with suicide attempts: A retrospective study from single national level 1 trauma center p. 92
Hassan Al-Thani, Ahammed Mekkodathil, Rafael Consunji, Monira Mollazehi, Adham A Ammar, Ashok Parchani, Hisham Jogol, Suhail Y Hakim, Ahad Kanbar, Ayman El-Menyar
DOI:10.4103/IJCIIS.IJCIIS_64_19  
Background: Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods: We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results: During this 10–year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions: The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.
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Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients p. 99
Amir Vahedian-Azimi, Farshid R Bashar, Marina N Boushra, Joseph W Quinn, Andrew C Miller
DOI:10.4103/IJCIIS.IJCIIS_37_20  
Objectives: The negative inspiratory force (NIF) has been used to help clinicians predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH2O may not be appropriate for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients. Methods: A prospective-observational multi-center study was conducted in intensive care units of six academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive, and negative predictive value (PPV, NPV), positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy recorded. Results: A total of 90 patients with COPD (39 males and 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation (P = 0.654). The threshold value of ≤−25 cmH2O offered the optimal performance in COPD patients: area under the receiver operating characteristic (ROC) curves ROC curves 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, and NPV 95.6%., LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%. Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH2O was a moderate-to-good predictor for successful ventilator liberation, and outperforms the traditional threshold of ≤−30 cmH2O.
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