Traumatic Diaphragmatic Hernia.

Blunt traumatic diaphragmatic ruptures are uncommon yet associated with high mortality. They occur due to blunt or penetrating thoraco-abdominal injury. Diagnosis is often missed, and a high index of suspicion is vital. They may present acutely or delayed as respiratory distress or obstruction. They can be managed through a laparotomy or a thoracotomy and in the present day with minimal access surgery. We report an interesting case of blunt traumatic diaphragmatic hernia in a 48-year-old man presenting after abdomino-thoracic injury due to fall from height. He had herniation of the colon and stomach. Through a left subcostal incision, the herniated organs were reduced, and the diaphragmatic defect closed with prolene suture.

Prevalence of Falls and Risk Assessment for Falls Among Elderly in A Rural Area of Karnataka.

Background: Falls are extremely common among elderly population, accounting for substantial morbidity and mortality, and are often potentially preventable. Approximately 28-35% of people aged 65 yrs & above fall every year, increasing to 32-42% for those over 70 yrs (WHO). This study was designed for identification of risk factors among elderly, so that the future falls can be prevented. Objective: 1.To assess the prevalence of falls in elderly aged ≥60 yrs residing in a rural area in Bangalore 2.To assess the risk for falls and 3.To study the factors associated with the falls risk among these elderly. Materials and Methods: A cross sectional study was conducted in a village in Bangalore Urban District, Bangalore of Karnataka, among people aged ≥60 yrs during the period of July to August 2011. Demographic details, history of fall in the last one year were col-lected and falls risk was assessed. Data was analysed using SPSS16. Results: A total of 124 people aged ≥60 yrs participated in the study, 51(41%) were males and 73(59%) females. Prevalence of falls: 39(31.45%) people had history of at least one fall in the last one year averaging 1.25 falls per person per year. 32(82%) of them had one fall and 7(17.95%) experienced recurrent falls. Slip was the most common cause (51.3%) of the last fall. Risk for falls: 78(63%) elderly were having low risk, 12(9.6%) were in medium risk and 34(27.4%) were having high risk for falls. Risk was highest in 70–79 yrs age group and in females (P=0.003). On multivariate logistic regression analysis, people with hearing impairment (OR=10.09, CI=1.24-81.94), psychological im-pairment (OR=3.0, CI=1.19-7.55) and with history of falls in the last one year (OR=5.17, CI=1.98-13.49) had higher risk for falls and hypertensives (OR=0.25, CI=0.09-0.64) had lower risk. Conclusion: The study showed that there is a high prevalence of falls in elderly and more than 1/4th of the study population was at high risk. Psychological impairment, hearing impairment and history of previous falls significantly increased the risk of falling. Therefore, it is necessary to identify and address these problems and educate them on falls preven-tion.

Accidentes en el Hogar en menores de 15 años

De un total de 1658 niños accidentados menores de 15 años que acudieron al servicio de emergencias de la Clínica Infantil Dr. Robert Reid Cabral, en el período Noviembre-Febrero 1988-1989, 999 casos correspondieron a accidentes en el hogar; un 60.25% de los cuales 574 fueron del sexo masculino y 425 femenino; 57.46% respectivamente. Las edades más afectadas fueron los menores de 5 años, (71.37%), y la mayoría de los niños procedían de estrato socio-económico bajo, con 735 casos (73.57%). Resultó la cocina la habitación más peligrosa de la casa con un 14.81% de accidentes y 6 defunciones ocurrieron (4%) del total en ésta. De la población estudiada, 352 pacientes, ameritaron internamiento, encontrándose que 11 niños fallecieran como consecuencia del accidente, 3%