INTRODUCTIONTraumatic diaphragmatic injuries (TDIs) are clinically challenging. We aimed to review TDIs treated at a tertiary trauma centre over a 12-year period.

METHODSThis was a single-centre retrospective review of adult patients with TDIs treated between 1 January 2003 and 31 December 2014. Primary outcomes were mortality rates and Injury Severity Scores (ISS) associated with each TDI subtype. Secondary outcomes included proportions of TDIs diagnosed radiologically, operatively or during autopsy. We compared the TDI subtypes with respect to mechanism of injury, mortality rates and median ISS. Data was analysed using descriptive statistics.

RESULTSAmong 46 patients studied, the TDI subtypes noted were acute diaphragmatic herniation (n = 14, 30.4%), tears (n = 22, 47.8%) and contusions (n = 10, 21.7%). Patients with these TDI subtypes had a mortality rate of 35.7%-100%, while the ISS ranges for survivors and deaths were 22.0-34.0 (interquartile range [IQR] 6.5-23.0) and 53.5-66.0 (IQR 16.0-28.5), respectively. TDIs were identified via chest radiography (n = 2/33, 6.1%) and computed tomography (n = 6/13, 46.2%). All survivors (n = 21) and deaths (n = 25) underwent open surgery or autopsy, respectively, which confirmed TDIs. Blunt traumas and penetrating traumas were more frequently associated with acute herniation/contusions and tears, respectively. There were statistically significant differences among the TDI subtypes in their mechanism of injury, mortality rate and median ISS of survivors.

CONCLUSIONTDIs showed varying injury patterns with blunt versus penetrating mechanisms of injury, and were associated with significant mortality rates. Preoperative imaging had limited diagnostic use.

Objective: Leptospirosis in children is one of the most common diagnostic dilemmas, hence this study was performed to determine the clinical profile, outcome and risk factors associated with mortality in patients seen at tertiary government hospitals from January 2008 to December 2012. Methods: A case-control retrospective study was done among admitted patients at UP-PGH, SLH, and RITM. Descriptive statistics and multiple logistic regressions were utilized. Results: Among the 404 leptospirosis cases included in the study, 94% were male, with 43% belonging to 16-18-year-old age group (age range 3 to 18 years old). A higher occurrence was noted during the rainy season and in Manila. Clinical findings include fever, abdominal pain, calf tenderness, vomiting and conjunctival suffusion. Significant correlation was noted in patients with jaundice (p-value 0.014; OR 6.293, CI 1.449-27.335), dyspnea (p-value 0.004; OR 7.880, CI 1.967-31.561) and cardiac abnormality (p-value 0.042; OR 15.343, CI 1.106-212.853). Abnormal laboratory findings include neutrophilia, azotemia, creatinemia, anemia, elevated bilirubin levels and thrombocytopenia. Prolonged prothrombin time was associated with poor outcome (p-value 0.004, OR 23, CI 2.79-189.67). Penicillin was the drug of choice given to 96.8%. 94.6% of cases who had oliguric renal failure were conservatively converted to non-oliguric type. 5.4% underwent peritoneal dialysis and survived. Inotropes were used in 93% of non-survivors. The case fatality rate was 3.5% with the cause of death mostly due to Weil’s disease. The average hospital stay among survivors was 6.8+3.3 days as compared with 1.8+1.9 days in non survivors. Shorter hospital stay (p-value 0.00; OR 3.514, CI 2.115-5.839), as well as inotropic support (p-value 0.035; OR 62.511, CI 1.33-2949.134), were associated with poorer outcome, but these findings can be attributed to late presentation of cases at the hospital for admission. Conclusion A5 year review of patients with leptospirosis showed that jaundice, dyspnea, cardiac abnormality and prolonged prothrombin time were predictive of mortality.
Leptospirosis

INTRODUCTIONThis study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet.

METHODSPatients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires.

RESULTSA total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p < 0.001). The level of patient satisfaction was also significantly higher in Group A than in Group B (8.5 points higher, p < 0.001).

CONCLUSIONWhile the use of an iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study.