Musculoskeletal injuries are common in Cameroon. Negative pressure wound therapy (NPWT) can effectively manage complex wounds including open fractures, however high cost and unavailability prevent its widespread use. We sought to evaluate the feasibility and efficacy in Cameroon of a low-cost NPWT (LCNPWT) device built from an aquarium pump costing less than $100. We performed a prospective case series including all patients with musculoskeletal injuries managed with LCNPWT at Baptist Hospital Mutengene, Mutengene, Cameroon from 15th March 2021 to 15th March 2022. Patient demographics, wound characteristics, and wound photographs were collected at intake and at each dressing change (performed every 3 days). All treatment was provided inpatient, and outcomes were recorded at hospital discharge. Forty-one patients (mean age 40 years, 58% male) received LCNPWT. The most common injury mechanisms were road traffic-related accidents (n=16, 42%) and gunshots (n=8, 21%). Wound characteristics were recorded for 38 patients of which 24 (63%) had infected wounds and 3 were bacteremic (13%) on presentation. All patients received antibiotics. The average duration of LCNPWT was 5.9 days (standard deviation 3.1 days). For 15 patients with documented outcome data, LCNPWT was successful in achieving wound closure in 12 (80%). Five patients failed limb salvage, with 4 receiving amputations and 1 dying during hospitalization. Eighty-three percent of providers (15 providers) reported LCNPWT as beneficial in managing wounds. Low-cost NPWT device was effective for managing contaminated and complex wounds in a resource-limited setting.
Publications by Year: 2024
2024
OBJECTIVE: Concussion symptoms can be clustered into domains and understanding how multiple symptom domains present clinically may guide more accurate interventions. We investigate the associations between concurrent symptom domains and clinical recovery outcomes, as well as the role of sex in these relationships.
METHODS: We analysed data from the Ivy League-Big Ten Epidemiology of Concussion Study and included sport-related concussions (SRC) across five academic years 2015-2016/2019-2020 with complete data (n=1160). We used symptoms from the Sport Concussion Assessment Tool 22-symptom evaluation, previously categorised into symptom domains. Symptom profiles characterise how athletes endorse concurrent symptom domains. Outcomes are time (in days) from SRC to symptom resolution, return to academics, and full play.
RESULTS: Females more commonly endorsed headache, sensory, and affective symptom domains. Four classes/symptom profiles emerged: (1) 'low' on all domains, (2) 'high' on headache and sensory domains, (3) 'high' on vestibulo-ocular, cognitive, and sleep domains, and (4) 'high' on all domains. Time to symptom resolution, return to academics, and return to play were consistently shorter among class/symptom profile 1 compared with other classes/profiles. Compared with class/profile 1, the chance of having symptoms resolve was lower among classes/profiles 2, 3, and 4 (HR 0.74, 95% CI 0.63 to 0.88; HR 0.74, 95% CI 0.60 to 0.92; HR 0.50, 95% CI 0.43 to 0.57, respectively). Results were similar for return to academics and full play outcomes. Interactions with sex were not statistically significant.
CONCLUSIONS: Four symptom profiles characterised how concussion symptom domains co-occur. We found differences in recovery timelines among these groups, but not by sex. Findings inform and support targeted, symptom domain-specific interventions in concussion management.
PURPOSE: The use of a person's hands is crucial to their ability to succeed at work. Hand pathologies can impact work success by increasing absenteeism (ie, not being able to go to work) and presenteeism (ie, being able to work but in a reduced capacity). In this study, we quantified employed patients' presenteeism and absenteeism following carpal tunnel release or surgical fixation of a distal radius fracture (DRF).
METHODS: In this prospective cohort study, 91 patients (carpal tunnel syndrome [CTS]: n = 62; DRF: n = 29) from June 2022 to December 2023 were included. Baseline patient characteristics and patient-reported outcome measures (PROMs) were collected. Presenteeism and absenteeism were calculated using the World Health Organization's Health and Work Performance Questionnaire. Questionnaires were sought before surgery and at 3 and 6 months after surgery. Clinical improvement was determined using minimal clinically important difference (MCID) cutoff range estimates. The employee value of lost work was calculated as a percentage of the average patient in each group before surgery and at 6 months after surgery.
RESULTS: The average change in PROMs scores from before to after surgery at 6 months surpassed the low-end MCID estimates for all functional and pain-related PROMs. For patients undergoing surgery for CTS and DRF, retained employee value rose from 85.6% to 130.2% (ie, worked more than expected) and 52.7% to 56.9%, respectively.
CONCLUSIONS: Patients undergoing surgery for CTS or DRF have clinically appreciable improvement in functional and pain symptoms by 6 months after surgery. However, by 6 months after surgery, carpal tunnel release results in greater than complete employee value recovery, compared with surgical fixation of DRFs in which greater than 40% of the employee value remains lost after surgery. These findings can assist with preoperative expectation setting.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.