Objective: To evaluate the effects of an Alveolar Recruitment Maneuver on the reduction of complications, days of ventilation, ICU stay and mortality in ventilated patients.

Design: Trial with controlled background.

Scope: 500-bed University Hospital, 10-bed multipurpose ICU.

Patients: Patients ventilated from January 2010 to December 2012 with protective ventilation without MRA and patients ventilated using the same strategy and MRA from January 2013 to December 2015.

Interventions: Alveolar recruitment maneuver variant characterized by gradual increase of PEEP till doubling the previous value, with duration of two minutes and a frequency of three times a day.

Variables: Complications, days of ventilation, ICU stay and mortality.

Results: We included 97 patients in the control group and 101 in the trial´s group. The average days of ventilation were 6.81 in the control group and 6.79 in the study; the average ICU stay was 8.93 in the control group and 9.44 in the trial´s group. Patients in the trial´s group had fewer complications and mortality was 38.6%, lower than control (52.6%).

Conclusions: The two groups were homogeneous in terms of age, causes of ventilation, APACHE II, LIS index and Berlin classification. Mortality was lower than what predicted by the scales used in the trial´s group. Complications and mortality were significantly lower in the experimental group and there was no difference in relation to days of ventilation and ICU stay

Background: Acute poisonings commonly present to the Accident and Emergency (A&E) department, but specific epidemiologic data regarding poisonings in Botswana is limited in the current medical literature. This study was performed to generate patterns on which future studies and preventative programs can be based.

Methods: This is a retrospective chart review conducted on poisoning cases which presented to the A&E in Princess Marina Hospital (PMH) in Gaborone, Botswana from January 2016 to June 2016.

Results: 289 patients were seen in the A&E at PMH for acute poisonings. Of these, 57% were female. Of all the toxic exposures, 58% were intentional. Patients who were age 16-35 were more commonly affected than younger and older patients. While most patients were admitted, only 3 required ICU and the case fatality rate among all patients was 0.7%.

Conclusion: The rate of toxic exposure cases in Botswana appears to be increasing. Paraffin, paracetamol, snake bites, traditional medicines and unknown ingestions are the most commonly encountered poisonings presenting to the A&E in the first half of the year. Many of these are mild and can be discharged home without hospital admission; however, some are deadly and require close monitoring and aggressive care. Paraffin ingestion is quite common among children, at times fatal and almost always accidental making it an ideal target for public health initiatives. Women are more likely than men to ingest toxic substances and more commonly do so intentionally. This investigation was limited by its retrospective design, but shows basic patterns on which larger and prospective studies can be based.

Septic shock is an inflammatory response to an infection leading to cardiovascular dysfunction. Today, only few studies have evaluated whether cardiac dysfunction in septic shock is due to load modifications, neuroendocrine influence or intrinsic cardiac alterations. The isolated working heart approach allows measurement of cardiac function under controlled conditions. Our study demonstrated for the first time that in septic shock rat, alteration of cardiac function is characterized by both systolic and diastolic dysfunctions beside load conditions. This observation might help to apprehend the particular dysfunction associated with sepsis.

In Sepsis-3, sepsis and septic shock are defined as below. “Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total SOFA score ≥2 points consequent to the infection.” “Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.

Objectives: Horse riding as a recreational or professional activity can be more hazardous than motor cycle riding or motor vehicle driving. Pelvic and acetabular fractures following equestrian related accidents form only a small subset of commonly sustained injuries, and as a result there is a dearth of literature on this topic. This paper reviews a large group of injuries sustained in relation to equine activities, describes the common mechanisms and aims to highlight the severity of injuries in this patient group.

Methods and Results: Data from the registry of 3 databases (2 tertiary care hospitals in U.K and Australia, and the German National database) were collated. A total of 62 patients with an average age of 40.5 were obtained with the majority being female (14 males, 48 female). The mechanisms of injury were seen to fall in 4 main groups.
Group 1 included patients who had saddle injuries, Group 2 who were kicked by horse, Group 3 who were ejected by the horse and Group 4 who were ejected and either rolled on or trodden on by the horse. The severity of the injuries corresponded with the increasing energy or impact of the injuries.

Conclusion: Equine related injuries are often severe, and can include injuries similar to those more commonly seen following motorcycle accidents. An awareness of the mechanism of injury should draw attention to the possible diagnoses, and result in appropriate imaging and subsequent management. Trauma and emergency room staff should be aware of the range of injuries associated with this type of accident.