Papua and New Guinea medical journal
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Traumatic brain injury (TBI) has been responsible for 25-30% of surgical deaths in Port Moresby General Hospital (PMGH) over the last 30 years despite being responsible for only 5% of the admissions. ⋯ The case fatality rate of severe TBI has been reduced from 60% to just below 30% over the period of 2 years. The formation of a single unit managing TBI over two years may be one factor contributing to this improvement. Interpersonal violence has replaced motor vehicle accidents as the leading cause of death from TBI.
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Open wounds to the head with skull bone depression pose the potential for serious injuries to the brain parenchyma and an increased risk of infection. The treatment of these injuries aims to repair the breached dura as well as remove any nidus for infection. Open wounds to the head due to bullets pose special problems and have a high fatality rate. ⋯ Open depressed fractures and penetrating injuries form a small but significant group in the management of head injuries. The use of blunt objects, firearms and arrows coupled with increasing urban violence is responsible for most of these injuries. The outcome of patients admitted who are fully conscious is expected to be good. They can be managed by prompt debridement of the wound, elevation of the fracture and removal of fragments as appropriate. However, the mortality rate is high in those with a Glasgow Coma Score of 8 or less on admission, a finding indicative of the severity of brain injury beneath the wound.
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Given the lack of infrastructure in Papua New Guinea (PNG) traumatic brain injury (TBI) cases are usually not retrieved quickly to medical centres. Cases that eventually reach the hospital do so after the golden hour has passed. This means that the brain is already at risk of or is already subject to secondary brain injury. ⋯ The whole aim of neuroprotection is to protect the normal brain parenchyma from further injury. Secondary brain injury is minimized by reducing cerebral oedema and intracranial pressure, in order to improve cerebral blood flow and perfusion. This guideline describes the options for neuroprotection in PNG.
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Continuous appraisal of clinical indices with appropriate tests and their recording as evidence of treatment are conducive for evidence-based management of traumatic brain injury (TBI). Monitoring of various neurological indices and relating them to set parameters of TBI is imperative for gauging ongoing treatment. ⋯ The use of an ICP monitor and computed tomography (CT) scan is part of the standard repertoire of intensive care for the management of TBI. In Papua New Guinea where there are no ICP monitors or CT scan, the detection of increased ICP or intracranial mass lesions is done by thorough neurological examination complemented by monitoring of oxygen saturation, blood pressure and the Glasgow Coma Score.
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This is a cross-sectional study conducted intermittently in Port Moresby, the National Capital District of Papua New Guinea, from 1996 to 1997; Mt Obree in Central Province in October 2000; Upper Strickland River in April 2001; and the Balopa Islands in Manus Province in December 2002. The aim of the study was to determine the prevalence of high blood pressure and identify possible risk factors for hypertension in the 'healthy' population in Port Moresby and the three rural communities. There were 1491 subjects surveyed, 704 males and 787 females. ⋯ The mean systolic blood pressures of betelnut chewers in Port Moresby, Manus and Central were lower (by 1-9 mmHg) but higher--in males only--in Strickland. The mean diastolic blood pressures of betelnut chewers were lower in all study sites. Both high BMI (overweight and obesity) and older age were significantly associated with high systolic blood pressure but betelnut chewing was significantly associated with lower mean SBP (p < 0.001), a protective effect against systolic hypertension.