Chitra Joshi

Road traffic accidents in hilly regions of northern India: what has to be done?

BACKGROUND Road traffic accidents (RTA) are responsible for 1.2 million deaths worldwide each year. RTA will become the 3(rd) largest contributor to the global burden of diseases after ischemic heart diseases (IHD) and depression. We conducted a retrospective study on RTA in a tertiary center in the hilly district of Uttarakhand in India. METHODS The number of RTA, pattern of RTA, the number of patients killed and injured, the pattern of injury causing death and disability, the severity of accidents, and the type of disability were noted from December 2009 to November 2011. The accident severity was calculated as the number of patients killed per 100 accidents. The methods for reducing the incidence of RTA were observed, and the role of policy makers was studied. RESULTS The majority of deaths and disabilities in Uttarakhand were due to road traffic accidents in the hilly districts of the states. The most common cause of RTA was driving fault followed by defective roads. CONCLUSION Proper designing of roads and minimizing the fault of drivers are essential to prevent road traffic accidents in hilly regions.

Wooden stick penetration from the perineal region up to the thorax.

BACKGROUND Penetrating injuries of the perineum are rare but very dangerous. Since the genitourinary and colorectal organs may be injured, how to evaluate surgical management of the injury is very important. METHODS The present report presents a case of penetrating injury of the perineum by a wooden stick when the patient fell on the upright wooden stick from a tree. The three feet long stick entered the perineal region just left lateral to the anal opening. Upon reaching the thoracic cavity, it broke and only a foot stick was left in the subcutaneous plane. These injuries are potentially serious with risk of damage to multiple organs. Exploratory laprotomy was done, and bladder injury was repaired. The entry wound and the track of stick was thoroughly washed and allowed for secondary intention healing. RESULTS The post operative period was uneventful and the patient recovered fully. CONCLUSION Meticulous evaluation and surgical management of perineal injuries are the key to prevent devastating complications.

Comment on Olus Api et al.: Do asymptomatic patients require routine hemoglobin testing following uneventful, unplanned cesarean sections?

We commend the excellent paper titled “Do asymptomatic patients require routine hemoglobin testing following uneventful, unplanned cesarean sections?” [1]. In our experience, it is important to have a formal, written report stating blood group and hemogram in case a woman require a blood transfusion at any stage during the pregnancy or after the birth, due to excessive bleeding or hemorrhage. I would like to draw the attention of authors that although postpartum hemorrhage (PPH) due to cesarean scar dehiscence is an unusual complication, practitioners should add dehiscence to their diVerential diagnoses [2]. Another rare cause of delayed PPH is uterine artery pseudo-aneurysm [3]. Patients discharged home after cesarean sections in stable condition can visit emergency department due to bleeding. Secondary PPH deWned as excessive uterine bleeding occurring between 24 h and 12 weeks postpartum. The pathogenesis includes diVuse uterine atony or subinvolution of the placental site secondary to retained products of conception and/or infection, but the exact cause is often not known. The possibility of a bleeding diathesis should be considered, especially in women with a history of menorrhagia [4, 5]. These facts should be considered in the postoperative management protocol of both planned or uneventful and unplanned cesarean sections while ordering blood grouping, hemogram and tests for known bleeding tendency.