UT Southwestern Medical School
Permanent URI for this collectionhttps://hdl.handle.net/2152.5/6690
Welcome to the UT Southwestern Medical School’s electronic theses and dissertations (ETD) collection.
Most UT Southwestern ETDs are subject to a default embargo period of two (2) years from the date of degree conferral. These embargoed ETDs are unavailable until the embargo expires.
It might be possible to contact the author for more information before the end of the embargo. For assistance or more information, please contact the UT Southwestern Medical School Dean’s Office by email.
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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.
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Browsing UT Southwestern Medical School by Author "Abdelnaby, Abier"
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Item Characterization of Road Traffic Injuries at Hospital Traumatológico Ney Arias Lora in Santo Domingo, Dominican Republic(2020-03-16) Walsh, Maura Siobhan; Chang, Mary; Abdelnaby, Abier; Nwariaku, FiemuBACKGROUND: Over 1.35 million people die each year due to road traffic accidents (RTAs), and up to 50 million more sustain non-fatal injuries. They are the eighth leading cause of death worldwide, and the primary cause of death in young people between the ages of 15 and 29. Our study focused on RTAs in the second largest trauma hospital in the capital city of the Dominican Republic, Santo Domingo. The country currently claims the fifth spot globally for deaths due to road traffic accidents per capita, and is second globally for fatalities due to motorcycle accidents. OBJECTIVE: The objective of this study is to gather pertinent information about RTAs suffered by 362 patients admitted to Hospital Traumatológico Ney Arias Lora (HTNAL) to then inform interventions to decrease RTAs and the severity of their resulting injuries. METHODS: This study involves an analysis of several factors of RTAs suffered by patients admitted to HTNAL. These include gender, age, rural or urban location, the kind of vehicle, the number of passengers per vehicle; whether the patient was a driver, passenger, or pedestrian; the kinematics of the accident, the use and/or availability of 911, the distance from the hospital, time of day, the influence of alcohol, the use of a helmet or seatbelt, length of stay in the hospital, the kind of injury, the severity of the injury, and resulting permanent disability or death. Inclusion criteria were any patient admitted after sustaining injuries in a motor vehicle accident. There were no exclusion criteria. Researchers performed a retrospective paper chart review on 120 charts from 2013-2014, before the institution of a 911 system, and 125 charts from the beginning of 2017, after a 911 system had been in place for over two years. Due to lack of much of the data from the aforementioned list of factors within the charts, researchers also interviewed 117 patients and/or their family members who were admitted to HTNAL during July 2017. Verbal consent was obtained prior to each interview. RESULTS: Of the 362 patients included in this study, 85.4% were male and 14.6% were female. The mortality rate was 11.3% for males and 7.5% for females, for an overall rate of 10.8%. 12.9% of motorcyclists died in the hospital, compared with 2.9% of automobile occupants and 4.3% of pedestrians. Over half of the patients were involved in a traffic accident in Santo Domingo (52.3%). The average distance travelled for patients who were referred to HTNAL was 90.1 km. The highest frequency of accidents per hour occurred during evening rush hour on weekdays. The overwhelming majority of admitted patients were driving or riding a moto (two-wheel vehicles, such as motorcycles and mopeds), and this trend was more evident among males (81.7% of males, 49% of females). Only 21.8% of motorcyclists were recorded wearing a helmet, and none of the helmet users in this study died. The most common injury among motorcyclists was definite moderate/severe traumatic brain injuries (39.1%). Non-helmet users were 4.6 times more likely to suffer a TBI than those who did (95% CI: [1.4, 15.4]), and patients who suffered a definite moderate/severe traumatic brain injury were 11.6 times more likely to die than those who did not (OR = 11.6, 95%CI: (4.73, 28.22)). CONCLUSION: Death due to motor vehicle accidents is a public health crisis in the Dominican Republic. The root of this problem is multifactorial, as are the solutions. In this study, all of the deaths from motorcycle accidents were secondary to TBI in non-helmet users. This highlights one solution that could have a large effect on survivability after accidents--proper helmet usage. This could be done through public health campaigns, more rigorous enforcement of helmet laws, and programs to distribute helmets. Other possible solutions include improving data systems such as trauma registries and medical charting, continual assessment of road quality and identification of hotspots for accidents, and QI evaluations of pre-hospital care and trauma protocols.Item Epidemiology of Burns Treated by Yekatit 12 Burn Unit in 2016(2017-04-03) Mehta, Kajal Anil; Abdelnaby, Abier; Chang, Mary; Phelan, HerbBACKGROUND: Burns contribute significantly to the burden of disease, particularly in low and middle-income countries. There is a paucity of data regarding the epidemiology of burns in Ethiopia, and about burn injuries in Ethiopian urban settings. This study describes the epidemiology of burn injury admissions in a public tertiary care hospital burn unit. METHODS: A retrospective observational study was performed and the hospital records of the burn unit admissions, operating room logs and collected data sheets were utilized. All patients treated on an inpatient basis by the Yekatit 12 Hospital Burn Unit team between December 2015 and December 2016 were included in the study. RESULTS: A total of 184 burn hospitalizations were registered during this time period. Of the registered patients, 42.4% were female and 57.1% were male. The average age of the patients was 16.4 year old; 51.1% of patients were pediatric (<14 years old) with the average pediatric patient age of 4.36 years and average adult patient age of 29.4 years. Flame burns accounted for 35.8% of burns, scald 35.1%, electrical 27.8% and others <0.01%. The gender ratio was significantly dependent on the cause of burn (X2(10, N=184) = 35.9, p<0.0001), with males more likely to sustain electrical and scald burns (10.25 and 1.19 times the rate seen in females). The average total body surface area (TBSA) burned as calculated on the Lund-Browder scale, was 19.8% (n=77, SD=18.2). In admitted patients, 52.7% underwent operative treatment, with most frequent operation being split-thickness skin graft (STSG). The mortality rate was 13.3% (n=105). CONCLUSION: This is the most recent epidemiological study of burn patients in an urban setting in the last 15 years in Ethiopia. This research highlights the current picture of burn injuries in Addis Ababa. Many of the results are consistent with the literature of scald and flame burns being the predominant etiology, and a mortality rate of 13.3%. Though this study is limited by incomplete data, the proportion of burns due to electrical burns was higher than has been previously demonstrated, and thus warrants further study.Item Harm Reduction of Unsafe Abortion in Latin America(2015-03-20) Studer, Eva; Mihalic , Angela; Abdelnaby, Abier; Grimes , ClariceUnsafe abortion is one of the major causes of maternal morbidity and mortality in the developing world. Most unsafe abortions occur where abortion is legally restricted. Like many Latin American countries, Argentina prohibits abortion in most circumstances, and maternal mortality from unsafe abortion is high. While spending three months in Buenos Aires, I met an organization called Socorristas en Red (Network of Helpers). This is an organization that provides women seeking illegal abortions with information about safely using misoprostol to induce medical abortions. In my presentation I will discuss how Socorristas en Red has decreased the harm of unsafe abortion in Argentina by providing women seeking illegal abortions with information on misoprostol as a safer alternative.Item Pediatric Cardiac Surgery in Developing Countries of Africa: Current State and Future Direction(2014-04-11) Lee, Kyongjune Benjamin; Mihalic, Angela; Abdelnaby, Abier; Nwariaku, Fiemu; Jones, EugeneSurgical services are often the most neglected part of medical care in developing countries of Africa. Cardiac surgical care is even less accessible in comparison due to its need for highly skilled individuals and sophisticated equipment. This lack of proper care places the pediatric population affected by cardiac conditions without much hope for the future. Combining my clinical experience overseas with an extensive literature review, I examined the current state of pediatric cardiac surgery in several developing countries of Africa, and possible future efforts for establishing a viable cardiac surgery centers in low-resource settings. I examined in detail the two most prominent cardiac conditions in the developing world: congenital heart disease and rheumatic heart disease. The review of literature showed that cardiac surgical care is a serious need in many developing countries. It also revealed that with careful long-term international collaboration between institutions, a self-sustainable and economically viable cardiac surgical center with reasonable outcome can be established.