Background: Trauma is a significant public health challenge, particularly in low- and middle-income countries (LMICs), including South Africa, where it contributes to substantial morbidity, mortality, and economic burden. Accurate data on trauma epidemiology is crucial for informing prevention and care strategies. Purpose: This study aimed to describe the epidemiology of trauma patients presenting to one of the largest tertiary care public hospitals in Johannesburg, South Africa, focusing on injury patterns and outcomes. Methods: This retrospective observational study analysed data from the hospital's trauma registry for patients presenting between January 2022 and June 2022. Data collected included demographics, injury mechanisms, and outcomes (admission to ward, ICU, theatre, discharge, death). Results: A total of 377 trauma patients were included in the study. The majority were adult males (79.84% adults, 83.82% males). The most common injury patterns were stabbing (32.63%), gunshot wounds (14.59%), and assaults (13.53%). No significant association was found between patient demographics (sex and age group) and outcome. Conclusion: This study confirms the significant burden of trauma in a large urban centre in South Africa, particularly among young adult males, with interpersonal violence being a major contributing factor. The high prevalence of violence-related injuries underscores the importance of implementing and strengthening public health interventions aimed at preventing violence.

Introduction: Pneumatosis Cystoides Intestinalis (PCI) is a fairly rare condition that is, however, becoming of increasing incidence. It is difficult to ascertain as many patients are asymptomatic, but, in adults, if it does present it usually presents in the fifty-to-eighty years age groups. Importance: It may be primary (15% - idiopathic and benign condition) or secondary (85% - usually in neonates and due to necrotising enterocolitis) but the aetiology is unclear, with some theories that have been put forward. Many consider its pathogenesis to be due to increased intra-luminal intestinal pressure and, therefore, build-up of gas from commensal gut bacteria. Imaging and histology are important in diagnosis. Case presentation: This case presentation explores the complicated presentation of a patient with PCI and his management, thereof, in order to review the appropriate investigations and the subsequent options of management. Conclusion: Because it is a poorly understood condition with varying presentations, it is often misdiagnosed. The diagnosis is critical to allow the correct and most appropriate management to be carried out: non-surgical supportive care versus surgical intervention with resection and stoma or anastomosis. HIGHLIGHTS Pneumatosis cystoides intestinalis: presentation and management of a complicated case. Pneumatosis Cystoides Intestinalis (PCI) is a fairly rare condition and is difficult to diagnose as many patients are asymptomatic. Imaging and histology are key the in diagnosis and subsequent non-surgical versus surgical management. This case presentation explores the complicated presentation of a patient with PCI and his management, along with some associated concurrent diagnoses.

The dress code for surgeons has evolved over time from formal suit-and-tie to crisp white coat, and currently to various forms of smart-casual attire; however, there is no stipulated or rigid uniform guideline. It is important to explore and discuss the various forms of attire in relation to patients' ideals and perceptions of a surgeon. An observational study in the form of a paper-based questionnaire was carried out at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Academic Hospital (CHBAH) and Wits Donald Gordon Medical Centre (WDGMC). Seven questions (Q1-Q7) were posed with various dress categories to select from in each question, namely: formal, smart, smart-casual and scrubs. Descriptive analysis of the survey responses, and the determination of the association between survey responses and a) hospital, b) gender, c) age group was performed. Fisher's exact test was used where the requirements for the chi-square test could not be met. Attire groups with n < 15 were not analysed. The strength of the associations was measured by Cramer's V and the phi coefficient respectively. Data analysis was carried out using SAS v9.4 for Windows. A 5% significance level was used. A total of 387 questionnaires were filled out with a total of 376 fully completed and eligible samples in consenting participants of 18 years and older. In all seven questions, scrubs were the preferred attire. Overall, for Q1-Q5 and Q7, after scrubs, smart was the next most popular attire. For Q6, after scrubs, smart, smart-casual and formal were all popular, indicating some leeway on weekends and public holidays. There was a significant association between each of the responses to the question and hospital (p < 0.0001). At CHBAH, patients preferred scrubs more and smart attire less, compared to CMJAH and WDGMC. At CMJAH, preference for formal attire was greater when compared to the other two hospitals. Overall, patients preferred their surgeons to be dressed in scrubs as this attire easily identified surgeons and instilled confidence in the wearer.

Introduction: Le Fort fractures occur in approximately 20% of facial fractures and result from a high velocity/force mechanism of injury. In those rare 20% occurrences, the Le Fort III fractures are the least common and are highly associated with injuries of the cervical spine, intracranial, and internal neck structures. Importance: This makes them difficult to manage and requiring a definitive sequence of resuscitation and thorough secondary and tertiary surveys thereafter. The morbidity and mortality of these severe fractures is high but with appropriate resuscitation and adequate stabilization of the fracture, this may be improved on and lowered. Case presentation: A male sustaining multiple stabs to the face presents to a level one trauma emergency unit haemodynamically unstable/abnormal with a threatened airway and stridor. Discussion: This case report walks through step-by-step the management approaches at each stage thereby assessing and managing the outcomes of each diagnosis. Conclusion: Le Fort III fractures are rare but critical injuries that require intensive resuscitation and a multidisciplinary approach to achieve wholistic and appropriate management of these patients. Adequate initial resuscitation and stabilization of fractures may improve the morbidity and mortality of these sever injuries.

Background: Penetrating cardiac injuries (PCIs) remain a significant surgical challenge, characterized by high mortality rates, particularly in young adult males. The mechanism of injury (gunshot wound vs. stab wound) significantly influences outcomes. Importance: This study presents two cases of left ventricle PCIs, emphasizing the need for prompt diagnosis and intervention. The rising incidence of PCI necessitates a high index of suspicion based on clinical findings and basic imaging to facilitate timely surgical intervention and potentially improve survival. Case series: Two patients presented within 48 hours at a South African hospital. Case 1 involved a 32-year-old male with a stab wound to the anterior left ventricle, injuring the left anterior descending artery. Case 2 involved a 26-year-old male with a gunshot wound (GSW) to the posterior left ventricle. Both underwent immediate surgical repair. Discussion: The clinical presentations, diagnostic approaches (including eFAST), and operative techniques are described. Postoperative courses varied significantly; one patient developed complications including severe hypertension and Takotsubo cardiomyopathy, while the other had an uncomplicated recovery. A literature review highlights inconsistencies in reported PCI incidence and mortality, largely attributed to small sample sizes and methodological limitations in previous studies. Conclusion: The increased frequency of GSWs and stab wounds causing PCIs underscores the importance of a high index of suspicion supported by clinical findings and basic imaging to enable rapid surgical intervention. This expeditious approach could potentially improve mortality rates. Further research with larger, well-designed studies is crucial to refine our understanding of PCI management and improve outcomes.

Trauma mortality exhibits three peaks: immediate, early, and late post-traumatic. Early deaths are often due to haemorrhage and central nervous system injury, whereas late deaths are associated with sepsis and multi-organ failure. The neutrophil-lymphocyte ratio (NLR) is a readily available and inexpensive marker of inflammation, and its prognostic value under various conditions has been established. However, the predictive ability of the NLR in trauma mortality remains unclear, with conflicting results from previous studies. This study aimed to investigate the correlation between NLR (on admission and at 48-hour post-admission) and trauma outcomes. This retrospective study analysed data of trauma patients (≥ 18 years old) of which 372 were admitted to a level one trauma unit between January and June 2017. The data collected included demographics, mechanism of injury, injury severity score (ISS), new injury severity score (NISS), abbreviated injury scale (AIS), hospital length of stay (LOS), hospital disposition, and NLR values on admission and at 48 hours. Logistic regression models were used to analyse the association between the NLR and mortality, controlling for age, sex, ISS, and AIS. The sample size was calculated based on the anticipated mortality rate and desired power. The study included 288 patients for admission NLR analysis and 165 patients for the 48-hour NLR analysis. While factors such as ISS, NISS, emergency department (ED) probability of survival, NISS EU probability, and hospital disposition significantly predicted mortality, NLR at both 24 and 48 hours was not significantly associated with mortality. Although NLR showed good diagnostic accuracy, it did not improve the predictive power of the models, including established prognostic factors. The small sample size for 48-hour NLR analysis is a limitation. Although the NLR is a simple indicator of systemic inflammation, this study found that it does not independently predict mortality in trauma patients when other established prognostic markers are included. These findings suggest that NLR has limited additional prognostic value in this context, highlighting the importance of incorporating established injury severity scores and other clinical factors for accurate mortality risk assessment. Further research with larger sample sizes is needed to confirm these findings and explore the potential role of the NLR in predicting other trauma outcomes.