Ashraf F. Hefny

Seatbelts and road traffic collision injuries

Modification of seatbelts and their legislation played an important role in reducing morbidity and mortality of occupants in road traffic collisions. We aimed to review seatbelt development, its mechanism of action and its effects. Seatbelts reduce injury by preventing the occupant from hitting the interior parts of the vehicle or being ejected from the car. We have made a linear regression correlation between the overall seatbelt compliance and road traffic death rates in 46 high income countries to study the relationship between seatbelt use and mortality. There was a very highly significant negative correlation between the seatbelt compliance and road traffic death rates (R = - 0.77, F = 65.5, p < 0.00001). Seatbelt-related injuries include spinal, abdominal or pelvic injuries. The presence of a seatbelt sign must raise the suspicion of an intra-abdominal injury. These injuries can be reduced if seatbelts were applied correctly. Although seatbelts were recognized as an important safety measure, it still remains underused in many countries. Enforcement of seatbelt usage by law is mandatory so as to reduce the toll of death of road traffic collisions.

Clinical ultrasound physics.

Understanding the basic physics of ultrasound is essential for acute care physicians. Medical ultrasound machines generate and receive ultrasound waves. Brightness mode (B mode) is the basic mode that is usually used. Ultrasound waves are emitted from piezoelectric crystals of the ultrasound transducer. Depending on the acoustic impedance of different materials, which depends on their density, different grades of white and black images are produced. There are different methods that can control the quality of ultrasound waves including timing of ultrasound wave emission, frequency of waves, and size and curvature of the surface of the transducer. The received ultrasound signal can be amplified by increasing the gain. The operator should know sonographic artifacts which may distort the studied structures or even show unreal ones. The most common artifacts include shadow and enhancement artifacts, edge artifact, mirror artifact and reverberation artifact.

Motorcycle-related injuries in the United Arab Emirates

OBJECTIVES To study the anatomical distribution, severity, outcome, and age by nationality of hospitalized motorcycle-related injured patients in Al-Ain, United Arab Emirates so as to improve preventive measures. METHODS All motorcycle riders involved in a road traffic collision and admitted to Al-Ain Hospital for more than 24 h or who died in hospital after arrival were studied. Patient data were retrieved from Al-Ain Hospital Trauma Registry. Data had been prospectively collected during four and half years (March 2003-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Hospital stay, mortality, nationality, time, day of week, and month of occurrence were analyzed. RESULTS There were 95 patients (93 males). Mean (SD) age was 29.8 (11.5) years. 35% were United Arab Emirates (UAE) nationals. Upper limbs were most frequently involved (54%) followed by lower limbs (48%), head (41%), and face (30%). On arrival at hospital, median (range) ISS was 4.5 (1-36) and median (range) GCS was 15 (3-15). Mean (range) hospital stay was 8.8 (1-79) days. 14 patients (15%) were admitted to the Intensive Care Unit. In-hospital mortality was 6%. UAE national victims were significantly younger and had more abdominal injuries than expatriates, who had lower limb injuries. CONCLUSIONS The most common mechanism of motorcycle crashes was hitting a moving vehicle. Young UAE national motorcyclists are at a higher risk of being injured compared with non UAE nationals. This may be due to risk-taking behavior of young motorcyclists who are mainly riding for leisure. Extremities were the most common injured body region. Severe head injury was the main cause of death. This signifies the need for effective application of motorcycle helmet law in the UAE along with other preventive measures that might include increasing the licensing age.

The role of ultrasound in the management of intestinal obstruction

Intestinal obstruction (IO) is a common cause of acute abdominal pain. The recent increased use of sonography in the initial evaluation of abdominal pain has made point-of-care ultrasound a valuable tool for the diagnosis of IO. Sonography is as sensitive, but more specific, than plain abdominal X-ray in the diagnosis of IO. Point-of-care ultrasound can answer specific questions related to IO that assist the acute care physician in critical decision making. Sonography can also help in the resuscitation of patients by serial measurement of the IVC diameter. We review the sonographic findings of IO and the role of point-of-care ultrasound in the management of patients having IO.

Seatbelt compliance and mortality in the Gulf Cooperation Council countries in comparison with other high-income countries

Background and Objectives : Mortality from road traffic collisions (RTC) is a major problem in the Gulf Cooperation Council (GCC) countries. Low compliance with seatbelt usage can be a contributing factor for increased mortality. The present study aimed to ascertain the presence of a relationship between seatbelt non-compliance of vehicle occupants and mortality rates in the GCC countries versus other high-income countries. Design and Setting : Observational and descriptive study using information published by the World Health Organization Methods: Data for all GCC countries (n=6) and other high-income countries (n=37) were retrieved and compared with regard to population, gross national income, number of vehicles, seatbelt non-compliance and road traffic death rates. Univariate and multivariate analysis were used to define factors affecting the mortality rates. Results: The median road traffic death rates, occupant death rates, and the percentage of seatbelt non-compliance were significantly higher in the GCC countries (P<.0001, P=.02, P<.001, respectively). There was a strong correlation between occupant death rates and seatbelt non-compliance (R=.52, P=.008). Seatbelt non-compliance percentage was the only significant factor predicting mortality in the multiple linear regression model (P=.015). Conclusions: Seatbelt non-compliance percentages in the GCC countries are significantly higher than in other high-income countries. This is a contributing factor in the increased road traffic collision mortality rate in these countries. Enforcement of seatbelt usage by law should be mandatory so as to reduce the toll of death of RTC in the GCC countries.

Sonographic diagnosis of intraperitoneal free air

Detection of intraperitoneal free air is important for the diagnosing of life-threatening conditions in patients with acute abdominal pain. Point-of-care ultrasound is an extension of the clinical examination in patients presenting with acute abdomen. Failure of sonographers to detect intraperitoneal free air was clinically considered as a limitation of abdominal ultrasound. It is now increasingly appreciated that ultrasound may detect intraperitoneal free air. Emergency physicians should be familiar with the sonographic features of intraperitoneal free air which may be essential to recognize bowel perforation. Herein we review the literature on the sonographic findings of intraperitoneal free air and the technical manoeuvres that can improve clinicians’ detection of intraperitoneal free air using point-of-care ultrasound.

Camel bite injuries in United Arab Emirates: A 6 year prospective study

PURPOSE To prospectively study the incidence, mechanism, distribution of injury, and outcome of patients admitted to Al-Ain Hospital with camel bite injuries in Al-Ain, United Arab Emirates. METHODOLOGY All patients admitted to Al-Ain Hospital with a camel bite were prospectively studied during the period of October 2001-October 2007. Patients demography, mechanism of injury including behaviour of the camel, distribution and severity of injury, and outcome were studied. RESULTS 33 patients were studied having a median (range) age of 27 (10-58), all were males. 97% were from the Indian subcontinent. A majority of injuries (73%) occurred during the camel rutting season (November-March). Twenty-five patients were camel caregivers whilst five were camel jockeys. All camel jockeys were children. Seven patients were raised up by the camels mouth and thrown to the ground whilst 26 patients were only bitten. Most injuries were in the upper limb (64%) and head and face (15%). 48% of upper limb injuries had associated fractures. Two patients who were bitten at the neck were admitted to the ICU. One of these died due to massive left-brain infarction and the other had complete quadriplegia due to spinal cord injury. The median hospital stay was 6 days. There was only one death (3%). CONCLUSION The behaviour of the camel is occasionally unpredictable, especially during the rutting season. The mechanism of camel bite injuries, which are usually severe, are complex including penetrating and crushing injuries by the camel jaw and blunt injuries when patients are picked up and thrown away. Care should be taken when handling camels, particularly in the rut.

Bicycle-related injuries requiring hospitalization in the United Arab Emirates

OBJECTIVES To study the anatomical distribution, severity, and outcome of bicycle-related injuries requiring hospitalization in Al-Ain city, United Arab Emirates in order to improve preventive measures. METHODS All patients with bicycle-related injuries who were admitted to Al-Ain Hospital or who died after arrival were studied. Data were prospectively collected over a period of six years (October 2001-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), hospital stay, and mortality were analysed. RESULTS There were 130 patients (126 males). Mean (SD) age was 27.1 (14.5) years. 17.7% were United Arab Emirates (UAE) nationals. None of the patients was wearing a helmet. The percentage of UAE nationals of less than 15 years old was significantly higher (65.2%) than non-UAE nationals (14.3%) (p<0.0001, Fishers Exact Test). The most common mechanism of injury for UAE nationals was falling from a bicycle (73.7%) whilst for non-UAE nationals was hitting a moving vehicle (66.7%). 96 (73.9%) patients had head and face injuries whilst 91 patients (70%) had extremity injuries. On arrival to the hospital, the median (range) ISS was 4 (1-41) and the median (range) GCS was 15 (3-15). The median (range) of total hospital stay was 4 (1-95) days. 17 patients (13.1%) were admitted to the Intensive Care Unit. Two patients died because of head injury (overall mortality was 1.5%). CONCLUSIONS The majority of hospitalized injured cyclists in our study were low income adults using cycling as a cheap transportation method. Compulsory helmet use by bicycle riders and subsidising helmet cost should be adopted so as to reduce morbidity and mortality of bicycle-related injuries.

Severe tyre blast injuries during servicing

BACKGROUND The destructive potential of the tyre explosions has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. These blasts mainly affect the personnel servicing big vehicle tyres such as trucks and buses. We aimed to review the relevant literature on tyre blast injuries so as to define the mechanism of injury, outcome, and its methods of prevention. METHODS A search of the English literature on tyre blast injuries was performed through Medline. Different studies were retrieved, analysed and combined together. RESULTS A total of 763 patients were studied in the literature. Most of the patients were young aged male mechanics and the explosions usually occur during tyre servicing especially during inflation. Injury is caused by the pressure impact of the explosion or by direct hit of the rim. The head and face are the most commonly affected regions (48%) followed by the upper limbs (20%). About 25% of patients had multi-trauma. The overall mortality is high (19%) and is mainly caused by head injuries. CONCLUSION Inflated large tyres contain a tremendous amount of potential energy. Tyre blast injuries during servicing have a high morbidity and mortality. Preventive occupational methods should be implemented.

Actinomycosis of the Gallbladder: Case Report and Review of the Literature

Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphys sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.