PROF. HASSAN SAIDI

Background: Elderly patients have worse outcomes for similar severity when compared to younger trauma patients. Elderly patients form smaller proportions of the trauma population in the developing world in comparison to high in-come countries. Due to limited data capabilities, elderly trauma has been infrequently studied. Objective: To describe the common injuries that afflict elderly trauma patients associated resource utilization and the determinants of outcome in Kenyan urban hospital. Methods: Seventy two patients aged 60 years and older admitted for trauma from diverse mechanisms, were recruited over a period of one year (November 2009-December 2010). Data on the specific mecha-nism and type of injury, age, sex, intensive care unit (ICU) use, hospital length of stay, and cost were recorded. Survi-vors and those who died during admission were compared to determine associated factors. Elderly patients were also compared to younger trauma patients to determine significant group peculiarities using X2 analysis or Fisher’s exact test as appropriate. Results: Elderly trauma cases (mean age 70.5 + 9.1 years) formed 4.5% of all trauma admissions during the study period. The intent was accidental in 84.7% of cases. The predominant mechanisms of injury were traf-fic (44.4%) and falls (41.7%). Females comprised 41.7% of all patients and lower limb fractures predominated (54.9%). The average injury severity score was 7.82 + 4.4. (median 9.0). The proportion admitted to the ICU was 6%. The me-dian length of hospital stay was 24 days, cost of treatment Kshs. 27,153 Kenya shillings and overall hospital mortality rate was 13.9% (25% for ISS > 15). Only gender and head injury were predictors of mortality. Conclusions: Traffic and falls are the predominant mechanisms in geriatric trauma in Kenya. Unique features of geriatric trauma are higher fe-male involvement, prolonged length of hospital stay and fewer predictors of mortality compared to younger patients.

Atrioventricular annuli are important in haemodynamic flexibility, competence, and support for tricuspid and mitral valves. The anatomical features of the annuli, such as circumference, organisation of connective tissue fibres, myocardium, and cellularity, may predispose to annular insufficiency and valvular incompetence. These pathologies occur more commonly in females, although the anatomical basis for this disparity is unclear. Sex variation in the structure of the annuli is important in providing a morphological basis for the patterns of these diseases. This study therefore aimed to determine the sex variations in the structure of human atrioventricular annuli. One hundred and one hearts (48 males, 53 females) obtained from the Department of Human Anatomy of the University of Nairobi were studied. Annular circumferences were measured using a flexible ruler and corrected for heart weight. Results were analysed using SPSS version 17.0 and sex differences determined using student's t-test. A p-value of less than 0.05 was considered significant. For light microscopy, specimens were harvested within 48 hours post-mortem, processed, sectioned, and stained with Masson's trichrome and Weigert's elastic stain with van Gieson counterstaining. Females had significantly larger annular circumferences than males after correcting for heart weight (p ≤ 0.05). Histologically, myocardium was consistently present in all male annuli while this was absent in females except in one specimen. The annuli were more elastic and cellular in males especially in the annulo-myocardial and annulo-valvular zones, respectively. The corrected larger annular circumference in females may limit heart valve coaptation during cardiac cycle and may be a risk factor for valvular insufficiency. The predominance of myocardium, annular cellularity, and elasticity may be more protective against heart valve incompetence in males than in females