Double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula in uncircumcised patients with distal hypospadias / 亚洲男科学杂志(英文版)

Urethrocutaneous fistula may complicate hypospadias repair. We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula. The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula. A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital (Amman, Jordan). Boys who were aged between 6 months and 5 years, diagnosed with distal hypospadias, and not circumcised were included. The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The results showed a total of 163 boys with distal hypospadias; among them, 116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap, and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap. The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month, 6 months, and 12 months (6.9% vs 0, 10.3% vs 0, and 5.2% vs 0, respectively), and the difference after 6 months was statistically significant (P = 0.02).

A comparative assessment of the level of stockouts of modern family planning services in private and public health facilities in Nigeria

Background: The use of family planning (FP) methods and stockouts of contraceptives are major challenges to the FP program in Sub-Saharan Africa. This study assessed the level of stockouts of contraceptives in Nigerian health facilities. This survey was carried out in 767 health facilities offering FP services across all six geopolitical zones of Nigeria. Materials and Methods: This was a cross-sectional study involving a quantitative technique. Data were collected from 116 private and 651 public health facilities in Nigeria. A structured questionnaire was used to collect data from the facilities, and a physical inventory was taken. Data were analyzed using IBM-SPSS, version 25.0. Results: The stockout rate in the last 3 months was 63.8% in private and 47.5% in public health facilities (P = 0.001), whereas stockouts on the visit day were 63.8% in private and 51.0% in public facilities (P = 0.011). On the day of the visit, the stockout rate in private health facilities ranged from 9.3% to 26.5%, whereas it ranged from 5.3% to 24.2% in public health facilities. The main causes of stockouts of some contraceptives are low/no demand and a lack of supply. Conclusions: This study found a high level of stockouts of FP services in private and public health facilities, but higher in private facilities. Both the poor supply and low demand for FP services in Nigeria require the attention of policymakers and health officials.

Estimation of maternal mortality ratio with sisterhood method in six local government areas of Oyo State, Nigeria

Background: The reduction of maternal mortality rate has been the top priority of global health, yet its persistently high rate in Africa is a severe issue that requires the attention of both the individual and policymakers. Objective: To determine the maternal mortality rate by applying the sisterhood method in six local government areas in Oyo State. Materials and Methods: The indirect sisterhood method was used to collect data concerning maternal mortality. For study purposes, the data were collected from women in the reproductive age group between 15 and 49 years using a structured questionnaire. Statistical Package for the Social Sciences version 25.0 software was used for analyzing the collected data. Results: It has been observed that the average maternal mortality rate in the six local government areas was 489/100,000 live births ranging from 346 to 756/100,000 live births. The highest maternal mortality rate was found in Iseyin local government area (756/100,000 live births), followed by 586/100,000 from Saki, 444 from Ibadan North, 430 from Ogbomosho, 374 from Atiba, and the least value of 346/100,000 live births in Ibadan North local government area. Conclusion: The maternal mortality rate has been found lower than the previous studies but still unacceptably high, especially among adolescents aged 15–39 years. Therefore, it is advocated that policymakers employ appropriate interventions such as the release of more funds for standard family planning and childbirth spacing programs to minimize maternal mortality in the state.

Prognostic predictors of lymph node metastasis in penile cancer: a systematic review

ABSTRACT Purpose: Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC. Materials and methods: Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC. Results: We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM. Conclusions: A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.

Novel COVID-19 Pandemic Threat: Systematic Approaches To Preventing and Controlling Transmission in Eye Care System in Developing Countries

Background: 2019-novel coronavirus is a pandemic and major threat being how to avoid catching an infection. Purpose: To develop a working protocol to prevent and control community transmission of novel and life-threatening corona viral strain (COVID 19) in a tertiary eye care system of a tier-three city in developing counties such as India and underdeveloped countries. Methods: Prevention and control measures concerning staff training, working environment, staff health, patients, and outreach activities implemented and being practiced in our tertiary care ophthalmology hospital are focussed. Results: Proper and adequate training imparted by a qualified immunologist in addition to continual updates on disease out breaking news and guidelines to the employees. Ways to limit transmission within and between patients and staff are discussed in conjunction with the disinfection of equipment and high- and low-risk areas in a more frequent manner. Outreach camps are stopped in the obedience of the authorized governing bodies. Conclusion: This systemic approach developed based on our experience, and observational data will be useful in preventing transmission of this pandemic threat.

​Clinical Presentation and Management of Urethral Strictures: A Retrospective Study

Introduction: Male urethral stricture (US) disease is a common condition which results in narrowing or obliteration of the urethrallumen and may involve any segment of the urethra from the urethral meatus to the bladder neck.Aim: This study aims to study the clinical presentation and management of US.Materials and Methods: In this retrospective study, 200 patient’s data were analyzed. Stricture characteristics, investigations,treatment, and complications were recorded.Results: In this study, 190 (95%) males and 10 (5%) females were included in the study. The mean age of onset of USs was51 ± 7.28 years. The most common site of the occurrence of male US was the bulbar urethra (80 patients). Endoscopy opticalinternal urethrotomy was done in 60 patients and dilatation was done in 40 patients and 30 patients needed buccal mucosal graft.Conclusion: The US is a common disease that accounts for a considerable amount of morbidity and cost to the health-caresystem. Proper diagnosis and repair of the strictures are essential along with the appropriate imaging modality to prevent therisk of renal failure and to reduce morbidity.

Antibiotic susceptibility patterns of legionella pneumophila isolated from water lines of dental settings

Aims: the goal of the present study was to determine the in vitro antibiotics susceptibility of the L. pneumophila isolated from water of dental units

Methods and Results: Ninety dental units were screened at five teaching dental clinics in Najaf city during February to April 2016. Ninety four water samples were collected from air/water syringe, high-speed hand piece and water bottles of dental units, Totally 9 [9.5%] isolates of Legionella pneumophila were obtained using based charcoal yeast extract [BCYE] culture media and more confirmed by polymerase chain reaction [PCR] assay, The antibiotic susceptibility patterns of 16 antibiotics were studied by disk diffusion test. Present study revealed that all L. pneumophila isolates [100%] recorded fully resistant for ten tested antibiotics. At the same time over 75% isolates were resistant to amoxicillin and tetracycline. Except [55-66%] of isolates exhibited a partial susceptibility to ciprofloxacin, doxycycline and chloramphenicol. Eight [88.8%] of them were extensive resistant [XDR] isolates as well as, Amikacin was highly effective drug

Conclusions: We conclude that, high occurrence of XDR L. pneumophila isolates in contaminated water of dental units in Najaf hospital settings, which has been reported as an etiological agents for hospital-acquired respiratory tract infection

Significance and impact of study: Statistical analysis showed that may considered significant result [P < 0.05] of extensive drug resistance [XDR] isolates

The Association between Chronic Undernutrition and Malaria among Ethiopian Children Aged 6 - 59 Months: A Facility-Based Case-Control Study

Background. Malaria and undernutrition remain two major causes of childhood mortality in sub-Saharan Africa; including Ethiopia. The synergetic relationship between undernutrition and infection is widely documented but the relationship with malaria remains controversial. More studies are needed to address this and provide information to develop effective strategies for malaria control and prevention of undernutrition.Objective. To assess the relationship between malaria and chronic undernutrition in children aged 6 - 59 months at Bahir-Dar special zone; Ethiopia.Methods. A facility-based case-control study was employed to assess the relationship between malaria and chronic undernutrition at Bahir-Dar. A total of 621 children aged between 6 and 59 months; with a 1:3 ratio of confirmed malaria cases to controls; were enrolled. Clinical data and anthropometric measurements were taken; and blood film taken and examined. Anthropometric data were converted into nutritional indices using World Health Organization Anthro software version 3.2.2 and exported to SPSS for cleaning and analysis.Results. Prevalence of stunting and underweight was 50.3% and 34.2% among cases; respectively. Stunting and underweight were significantly associated with confirmed cases of malaria after sociodemographic and other variables were controlled. Other important predictors were rural residence; sleeping under long-lasting impregnated nets; and using indoor residual spray.Conclusion. Chronic undernutrition was closely associated with malaria infection. Major predictors for contracting malaria were stunting; underweight; rural residence; not using long-lasting impregnated nets and indoor residual spray; male sex and low educational status of mother/caregiver. Integrated actions targeting these factors are necessary to reduce the prevailing problem

Uremic pruritus in haemodialysis patients; prevalence, severity and possible associations

Background: Uremic pruritus is a common distressing complication of end stage renal disease and it is a common problem in dialysis patients. It causes serious discomfort and skin damage, negatively affects the quality of life

Objective: To determine the prevalence, severity of pruritus and possible association with the laboratory parameters in patients with chronic renal disease on haemodialysis

Methods: One hundred and three patients on chronic haemodialysis were included in this study. Fasting blood sugar, urea, creatinine, albumin, alkaline phosphatase, parathyroid hormone, sodium, potassium, chloride, calcium, phosphorus, calcium x phosphorus product, were determined

Results: Of the 103 patients included in the study the, 79 patients [76.7%] had pruritus of whom, 27 [34.1%] had mild pruritus, 30 [37.9%] had moderate and 22 [27.8%] had severe pruritus. No significant association [p> 0.05] was found between pruritus and each of sex, age, frequency and duration of haemodialysis. There was a significant association [p < 0.05] between duration of haemodialysis and pruritus onset. No significant difference [p > 0.05] in the FBS, urea, creatinine, albumin, parathyroid hormone, alkaline phosphatase, sodium, potassium, chloride, calcium, phosphorus, calcium phosphorus product, average among patients who had no pruritus, mild, moderate and severe pruritus. A significant positive correlation [p <0.05] was found between severity of pruritus in pruritic patients and age

Conclusion: We concluded that there was a significant association between duration of haemodialysis and pruritus onset more over the age had a significant positive correlation with the pruritus in pruritic patients

Study of antibacterial activity in the local Iraqi propolis

Objective: This study includes the investigation of antibacterial activity of the local propolis against four types of bacteria isolated from patients

Methods: Bacteria were tested including Psedomonas sp, Streptococcus sp, Escherichia coli and Staphylococcus aureus. Six concentrations [0, 5, 10, 15, 20 and 25] mg/ml of propolis extracts were tested against bacteria

Results: Results revealed the presence of significant difference [P < 0.05] in the effect of propolis extract against the four types of bacteria in this study. Psedomonas sp. was the most sensitive among the others toward the propolis extract followed by Streptococcus sp., E. coli and Staphylococcus aureus at a rate of inhibition zones [14.09, 10.39, 8.78 and 8.39] mm, respectively. Results of this study also showed increasing rate of inhibition zone if the concentration of propolis extract was increased

Conclusion: This study provided that local propolis has antibacterial activity against gram positive and gram negative bacteria

Health facilities for primary eye care in Sultanate of Oman. Primary eye care study 2000

Endeavor to improve [i] the quality of Primary Eye Care with the aid of an Eye Health Care Programme and [ii] the resourcing Primary Eye Care in Ministry of Health Institutions in 2001. Method: In this descriptive study, staff were randomly selected from 84 health institutions and representing 136 primary health institutions to carry out quality assurance procedures. Ophthalmologists trained in this evaluation were field staff who evaluated the resource status, such as health staff, space for eye care delivery, instruments, materials for health education, referring cases [for continuous medical education of the primary health staff], drugs for eye care, etc., in each health institution. In addition to availability, the standards of eye care delivery were also estimated. The health institutes of Oman have adequate resources for Primary Eye Care. Additional requirement of ophthalmic loupes and medicaments would further improve Primary Eye Care in Oman. It is recommended that such a review of the health care programme and its resources and quality be periodically conducted as a part of a system of quality assurance in primary health care

Acute renal fail ure in rasheed renal unit

84 patients with acute renal failure [ARF] were evaluated retrospectively in Rasheed Renal Unit [RRU] over a period of 9-months. They were 82 males and 2 females and their ages ranged 5-80 years. Prerenal ARF was the commonest type seen in 45 patients [53.6%]. Renal ARF was seen in 33 patients [39.3%] and acute obstructive uropathy in 6 patients [7.1%] .60 patients [71.4%] had ARF primarily. Clinically, 74 patients presented with oligoanuria while 10 patients only presented with non oliguria. Of the oligoanuric group, 61 patients [82.4%] needed RRT and 50 patients [67.6%] had complete recovery, the mortality rate was [25.7%] .while in the nonoliguric group non of them required RRT and complete recovery rate was 100% .The overall survival in both groups was [77.4%]. Other details concerning etiology and outcome will be discussed

Potential role for advanced trauma life support programme in improving trauma care in Jamaica

Data from the Road Safety Unit in the Ministry of Transport and Works, Jamaica, show an increase in road traffic accidents from 7861 in 1991 to 11,010 in 1999. The average number of deaths annually was 380 +/- 48 (SD) while injuries averaged 3320 +/- 262 per year. This represents an injury to death ratio of 8.7 compared with 24.9 for Trinidad and Tobago and 40 for Canada. During the period 1991 to 2000, an average of 796 +/- 159 (SD) murders were committed annually. The number of murders increased by over 280 per cent between the decade of the seventies and the nineties. Data from the trauma registry of the University Hospital of the West Indies showed that 29.6 per cent of all admissions to the surgical ward between January 1998 and December 31, 2000, were due to injuries. There were 97 deaths (3) during this period and 33 occurred in the Accident and Emergency Department with 70 per cent occurring within 120 minutes of their arrival. The Advanced Trauma Life Support (ATLS) Programme emphasizes the resuscitation and stabilization of injured patients in the first few hours after injury. Most Emergency Departments in Jamaica are staffed by relatively junior medical officers and the low injury to death ratio among victims of motor vehicle accidents may be due to suboptimal care. Introduction of an ATLS programme in Jamaica may reduce the number of preventable deaths and also stimulate interest in trauma care thus increasing preventative measures to decrease the high incidence of trauma in Jamaica

Improving medical undergraduate trauma education through the Trauma Evaluation and Management programme at Mona

This study examines the potential role of the Trauma Evaluation and Management (TEAM) programme in the undergraduate curriculum for medical students in Jamaica. Thirty-two final year medical students were randomly assigned to two groups of 16. One group (No TEAM) completed two 20-item multiple choice question (MCQ) examinations on trauma resuscitation topics. The second group (TEAM group) completed the first 20-item MCQ. The TEAM manual was then distributed to both groups. After the TEAM programme for both groups, the TEAM group had the second MCQ examination. Unpaired [quot]t[quot] tests were used for in-between group and paired [quot]t[quot ] tests for between group comparisons with p < 0.05 being considered statistically significant. Both groups completed a post-course questionnaire rating five items on a scale of one to five. The No TEAM group showed no difference in mean scores between the 1st and 2nd tests (55.3 in the 1st test to 52.2 in the 2nd test, p = 0.32). The TEAM Group improved their MCQ scores from 53.1 pre-module to 69.4 post-module (p < 0.001). A score of four of five was assigned by 28 students for the statement that the objectives were met, that trauma knowledge was improved and that there was overall satisfaction; by 17 students that clinical trauma skills were improved and 29 students that TEAM should be mandatory in the undergraduate curriculum. The TEAM programme improved trauma knowledge skills among senior medical students in Jamaica. The questionnaire results suggested enthusiasm for the programme and that it be made mandatory in the senior undergraduate medical curriculum

Interrupting Chagas disease transmission in Venezuela

The interruption of vectorial transmission of Chagas disease in Venezuela is attributed to the combined effects of ongoing entomoepidemiological surveillance, ongoing house spraying with residual insecticides and the concurrent building and modification of rural houses in endemic areas during almost five decades. The original endemic areas which totaled 750,000 km², have been reduced to 365,000 km². During 1958-1968, initial entomological evaluations carried out showed that the house infestation index ranged between 60-80 percent, the house infection index at 8-11 percent and a house density index of 30-50 triatomine bugs per house. By 1990-98, these indexes were further reduced to 1.6-4.0 percent, 0.01-0.6 percent and 3-4 bugs per house respectively. The overall rural population seroprevalence has declined from 44.5 percent (95 percent C.I.: 43.4-45.3 percent) to 9.2 percent (95 percent C.I.: 9.0-9.4 percent) for successive grouped periods from 1958 to 1998. The annual blood donor prevalence is firmly established below 1 percent. The population at risk of infection has been estimated to be less than four million. Given that prevalence rates are stable and appropriate for public health programmes, consideration has been given to potential biases that may distort results such as: a) geographical differences in illness or longevity of patients; b) variations in levels of ascertainment; c) variations in diagnostic criteria; and d) variations in population structure, mainly due to appreciable population migration. The endemic areas with continuous transmission are now mainly confined to piedmonts, as well as patchy foci in higher mountainous ranges, where the exclusive vector is Rhodnius prolixus. There is also an unstable area, of which landscapes are made up of grasslands with scattered broad-leaved evergreen trees and costal plains, where transmission is very low and occasional outbreaks are reported

Prevalence of asthma symptoms in Omani schoolchildren

To determine the prevalence of asthma in Omani schoolchildren using the International Study of Asthma and Allergies in Children [ISAAC] protocols. The ISAAC-written questionnaire was completed by a total of 7,067 Omani schoolchildren [3,893 children aged 6-7 years of which 56% were boys and 3,174 aged 13-14 years of which 51% were boys] from the 10 health regions in the country. The estimated mean national 12-month prevalence of any wheeze, night waking with wheeze, speech limiting wheeze and exercise wheeze were respectively 7.8%,3.5%, 3.2% and 6.9% for the 6-7 year age group and 8.9%, 2.9%, 4.0% and 19.2% for the 13-14 year age group. Both age groups reported high prevalence of night cough [19.6% and 20.9% in the younger and the older children respectively]. The prevalence of self-reported asthma diagnosis was higher in the older age group [20.7% vs. 10.5%, p < 0.001]. In the younger age group, the diagnosis of asthma was more common in boys [12.5% vs. 8.0%, p > 0.001], but there was no significant difference between the two sexes in the older age group [22.0% of boys vs. 20.5% of girls]. There was nearly three-fold difference in the prevalence of self-reported diagnosis of asthma between the regions with the highest and the lowest prevalence of asthma for both young and older children [from 5.3% and 9.5% in Musandam to 14.2% and 30.6% in South Sharqiya, respectively]. The results of this first epidemiological survey pf asthma in Oman indicate that asthma is common in Omani children and adolescents. Night cough is the most frequent symptom. There is also significant regional variation in prevalence of asthma symptoms and diagnosis within the country and this requires further investigation

Diabetes in Oman: Comparison of 1997 American diabetes association classification of diabetes mellitus with 1985 WHO classification

Diabetes mellitus [DM] is a major public health problem in Oman. We evaluated the impact of the revised diagnostic criteria for DM adopted by the American Diabetes Association [ADA] on the prevalence of diabetes and impaired glucose tolerance [IGT], and on the classification of individuals among the Omani population. Subjects and We used the dataset of the National Diabetes Survey, conducted in 1991 and involving 4682 subjects who did not have any missing data on fasting and 2-hour glucose. The subjects comprised 2002 males and 2680 females aged 20 years or above. Data were analyzed using the ADA criteria [diabetes as fasting plasma glucose [FPG] 7 mmol/L, impaired fasting glucose [IFG] as FPG 6.1 mmol/L and <7 mmol/L], and compared these with the World Health Organization [WHO] criteria [diabetes as FPG 7.8 mmol/L and/or 2-hour post-glucose load 11.1 mmol/L, IGT as FPG <7.8 mmol/L, and 2-hour post-load 7.8-11.1 mmol/L]. Applying the ADA criteria on the Omani population resulted in an overall reduction of diabetes prevalence by 2.2% [95% confidence interval [CI] 1.6% to 2.8%], and a 4.8% reduction of IGT [95% CI 3.8% to 5.8%]. Over 29% of diabetics classified by the WHO criteria were reclassified as being normal or having IFG by the ADA criteria. Around 3.6% of those who were normoglycemic by the WHO criteria were classified as having diabetes or IFG by the ADA criteria. In all but one region of Oman, the prevalence of diabetes and IFG using the ADA criteria was lower compared to the prevalence using the WHO criteria. Gender, age and body mass index did not seem to pose an increased risk to the probability of being diagnosed by one criteria or the other or both together. The adoption of the ADA criteria in Oman will significantly reduce the prevalence of diabetes and IGT. In addition, the glycemic status of a substantial number of individuals will be changed from normal to either being diabetic or having IGT

Epidemiology of perthes' disease in bahrain: no relationship to transient synovitis

A review of 91 patients with a discharge diagnosis of transient synovitis of the hip [TSH] from 1987 till 1995, none developed clinically overt perthes disease. No total hip arthroplasty has been performed to date for osteoarthritis secondary to perthes' disease. These facts lend support to the changing precept that there exists little relationship between perthes' disease and TSH. Hence, we see no reason for aspiration of the irritable hip exclusion of septic artritis. Radiographic follow-up of patients presenting with a single episode of transient synovitis of the hip is also unnecessary

Impact of the prehospital trauma life support programme in Trinidad and Tobago

The impact of the Prehospital Trauma Life Support (PHTLS) programme, introduced in Trinidad and Tobago in 1992, was assessed by questionnaires completed by 26 medical personnel (MP); 71 ambulance personnel (AP); and 50 non ambulance paramedical personnel (NAP). Of the 23 MP, 45 AP and 38 NAP who were aware of the programme, 19 (82.6) MP, 40 (88.9) AP and 25 (65.8) NAP were able to differentiate personnel that had taken the PHTLS programme based on their performance. 32 (71.1) of the AP were PHTLS trained. 24 (53.3) and 4 (9) of the AP identified poor equipment and poor supervision, respectively, as reasons for difficulty in applying PHTLS principles. Improvements observed among those completing the PHTLS programme were: improved resuscitation techniques by 20 (86.9) MP, 38 (84.4) AP and 27 (71.1) NAP; better vital signs recording by 8 (34.8) MP, 27 (60) AP and 8 (21.1) NAP; improved immobilization by 23 (100) MP, 40 (88.9) AP and 33 (86.8) NAP; better haemorrhage control by 22 (95.6) MP, 40 (88.9) AP and 24 (63.2) NAP; appropriate splinting of fractures by 23 (100) MP, 40 (88.9) AP and 32 (84.2) NAP; and increased utilization of oxygen by 15 (65.2) MP, 31 (68.9) AP and 21 (55.3) NAP. 32 (71.1) AP with PHTLS training indicated improvement in their ability to resuscitate and transport trauma victims, with 42 (93.3) reporting improvement in overall prehospital care. Medical, paramedical and ambulance personnel all perceive a significant positive impact of PHTLS training on prehospital trauma care. Although improvements in supervision, documentation and equipment are still required, improved trauma resuscitative techniques after PHTLS training should improve trauma patient outcome in Trinidad and Tobago.