Tetanus Antitoxin Research Articles

Neonatal tetanus in South Sudan: a case series

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes. Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan. Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available. Results: Unfortunately, all three neonates died within 24 hours of admission. Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness. Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

The role of magnesium sulphate infusion in controlling muscle spasms and rigidity in a child with severe generalised tetanus unresponsive to diazepam in a resource-limited hospital – a case report and literature review

Tetanus is an acute and potentially fatal spastic paralytic disease. This case aims to describe the role of magnesium sulphate infusion in controlling muscle spasms and rigidity in a child with severe generalised tetanus in a resource-limited hospital. A six-year-old unimmunised child with severe tetanus was brought to the emergency unit of the Kalabahi Regional Hospital. The patient was treated with intramuscular human tetanus immunoglobulin, intravenous metronidazole, and ceftriaxone. Diazepam infusion was administered and gradually increased to a dose of 140 mg/day. The patient was unresponsive to diazepam, so intravenous magnesium sulphate was administered at a dose of 100 mg/kg for 30 minutes, followed by an infusion at 40 mg/kg/hour. The patient responded well to the treatment and was discharged from the hospital on day 28. Magnesium sulphate infusion can be an effective adjunctive therapy to control muscle spasms and rigidity in children with severe generalised tetanus.

Delayed presentation and management approach of autonomic dysfunction associated with severe tetanus

Introduction: In 2019, there were over 73 000 estimated tetanus cases globally, including more than 27 000 cases of neonatal tetanus, and the worldwide deaths caused by tetanus were almost 34 684. The mortality rate of tetanus is greater than 50% in countries without ICUs and 10% in developed countries, mostly attributed to autonomic dysfunction. Countries with the greatest rates of post-neonatal tetanus mortality (greater than five fatalities per 100 000 people) were Somalia, South Sudan, and Kenya. Case presentation: A 66-year-old unvaccinated male patient came to our hospital emergency department with generalized rigidity, neck stiffness, lockjaw, and an altered level of consciousness for 5 days. His symptoms started with stiffness in his neck and back 4 days before. The patient was diagnosed with tetanus, as he was unimmunized, had a recent injury, and presented clinical findings. The authors started treatment by administering intramuscular human tetanus immunoglobulin and metronidazole. He was admitted to the ICU and placed in an isolation room with minimal auditory and visual stimuli. Following 2 weeks after admission his blood pressure began to fall, and his pulse rate started to fluctuate with alternating tachycardia and bradycardia. After 1 month in the ICU, he was discharged from the ICU and transferred to the ward. A catch-up immunization regimen was established. Clinical discussion: Tetanus is a rare condition in the Western world, primarily due to widespread vaccination programs from infancy to adulthood. There are crucial barriers that still exist to overcoming this disease in our country, including a lack of reliable immunization programs. In tetanus, the increase in survival is associated with the use of intensive care facilities for the management of tetanus, besides expanding the knowledge of the disease, which is a challenge for developing countries. Conclusion: It is essential to have enough immunization at an early stage of trauma since severe autonomic dysfunction linked to tetanus might be lethal.

Tetanus Update: Latest Diagnosis and Management

Tetanus still contributes to a large number of deaths with a case fatality rate (CFR) of 11.76% in 2019. The increase in the number of cases and inadequate reporting are the reasons why tetanus management remains an important part of reducing patient mortality. Tetanus almost always occurs in patients who are not immune, partial or immune is inadequate. The diagnosis is made only from clinical manifestations, where the rigidity and spasm can be generalized (including neonatal tetanus) or local. Management of tetanus is divided into general management - with the administration of human tetanus immunoglobulin (HTIG) or serum anti-tetanus (ATS), antibiotics, magnesium, and wound care - and special management - which conforms to Ablett's classification system: mild, moderate, severe, and very heavy. Meanwhile, management in primary health care still adjusts the guidelines given by taking into account the availability of drugs. Prevention is carried out by giving immunizations to pregnant women, neonates and babies, as well as giving a booster every time an injury occurs.

Seroprevalence of Diphtheria and Tetanus Immunoglobulin G among the General Health Population in Guangzhou, China.

A seroepidemiological study was conducted in 2018 to assess diphtheria and tetanus antibodies in Guangzhou, China. Diphtheria and tetanus antibody concentrations were measured with an enzyme-linked immunosorbent assay. A total of 715 subjects were enrolled in the study. The overall diphtheria and tetanus toxoid IgG-specific antibody levels were 0.126 IU/mL (95% CI: 0.115, 0.137) and 0.210 IU/mL (95% CI: 0.185, 0.240), respectively; the overall positivity rate was 61.82% (95% CI: 58.14, 65.39) and 71.61% (95% CI: 68.3, 74.92), respectively. The diphtheria and tetanus antibody concentration was decreased by age and increased by doses. The geometric mean concentrations and positivity rate of diphtheria and tetanus antibodies were lowest and below the essential protection level in people over 14 years of age. Compared to children and adolescents, middle-aged people and the aged are at much higher risk of infection with Corynebacterium diphtheriae and Clostridium tetani. The current diphtheria and tetanus immunization schedule does not provide persistent protection after childhood. There is an urgent need to adjust the current immunization schedule.

Venomous snakebites in children: a 10 year experience in South China

Introduction Many studies have focused on snakebites in adults, but very few have described snakebites in children. Methods We reviewed the clinical characteristics and outcomes of children with venomous snakebites aged less than 15 years who presented to a regional medical centre in South China from January 2013 to December 2022. Results A total of 69 envenomed patients were analyzed in our study; 42 (60.9 per cent) patients were male, and 59 (85.5 per cent) reported lower limb bites. Most bites (89.8 per cent) occurred between April and October. Twenty-seven patients received first aid management, and 47 required admission to the general ward. Antivenom was administered to 58 patients, glucocorticoids to 43 patients, antibiotics to 48 patients, and tetanus antitoxin to 40 patients. No fatalities were reported. The most common snake identified was Trimeresurus albolabris. Four were classified as dry bites, 15 as mild, 43 as moderate, and seven as severe. The most common local signs were pain and swelling, while the most common systemic effects were haematological complications. Patients with high severity scores had significantly higher lactate dehydrogenase activities, creatine kinase isoenzyme activities, aspartate aminotransferase activities, D-dimer concentrations, prothrombin times and lower fibrinogen concentrations. In a receiver operating characteristic curve analysis of the values with the highest Youden index, the following cut-offs proved significant: lactate dehydrogenase activity > 248.1 U/L, creatine kinase isoenzyme activities > 17.5 U/L, fibrinogen concentration < 1,455 mg/L, D-dimer concentration > 437.0 µg/L, aspartate aminotransferase activity > 26.1 U/L, and prothrombin time > 15.2 seconds. Discussion This study provides insight into the epidemiology, clinical profile, and management of snakebites in children. Data from the present study were compared with those from our previous adult study. Limitations include that 50.7 per cent of our snakebites were attributed to Trimeresurus albolabris. Therefore, the results of our study may not be generalizable to all snakebites. Conclusion The clinical symptoms were more severe in children than in adults in our previous study. Even though there were no fatalities, close monitoring should be performed to detect haematological and other potentially fatal complications promptly.

Evaluating the effect of equine tetanus antitoxin on mortality rates of dogs affected by tetanus

PICO Question In dogs with tetanus, does administering the equine tetanus antitoxin compared to not administering the antitoxin reduce mortality rates? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three studies were reviewed for this Knowledge Summary, all of which were retrospective case-control studies. Strength of evidence Weak. Outcomes reported There was no difference in survival to discharge between dogs treated and dogs not treated with equine tetanus antitoxin. Conclusion The current literature suggests that administering the equine tetanus antitoxin to dogs affected by tetanus had no positive or negative effect on mortality rates, though the level of evidence amongst the literature is weak. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Deficient Generation of Spike-Specific Long-Lived Plasma Cells in the Bone Marrow After Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Generation of a stable long-lived plasma cell (LLPC) population is the sine qua non of durable antibody responses after vaccination or infection. We studied 20 individuals with a prior coronavirus disease 2019 infection and characterized the antibody response using bone marrow aspiration and plasma samples. We noted deficient generation of spike-specific LLPCs in the bone marrow after severe acute respiratory syndrome coronavirus 2 infection. Furthermore, while the regression model explained 98% of the observed variance in anti-tetanus immunoglobulin G levels based on LLPC enzyme-linked immunospot assay, we were unable to fit the same model with anti-spike antibodies, again pointing to the lack of LLPC contribution to circulating anti-spike antibodies.

Successful management of severe tetanus in a 10-year-old unvaccinated girl: A case report

Tetanus is a potentially fatal disease caused by Clostridium tetani, which produces muscle spasms, autonomic dysfunction, and respiratory failure by the action of a powerful neurotoxin. Tetanus can be prevented by vaccination, proper wound care, and tetanus prophylaxis, but it remains a significant public health concern in regions with inadequate vaccination coverage. We report a case of severe tetanus in an unvaccinated 10-year-old girl following a tetanus prone injury on her right big toe and was treated with antibiotics, tetanus immunoglobulin, tetanus toxoid, sedatives, neuromuscular blockers, and tracheostomy with mechanical ventilation. She recovered after 28 days of supportive multi-disciplinary intensive care and was discharged with no neurological sequelae.

Snakebites and Antisnake Venom Utilization in Ghana's Oti Region: A 6-Year Retrospective Study.

Background: Snakebite is a global environmental and occupational hazard and a significant public health threat. In rural areas, snakebite cases often go unreported and undocumented due to the lack of access to well-structured healthcare facilities/infrastructure. In some cases, the need for antisnake venom (ASV) far outstrips supply, negatively affecting treatment outcomes. This study, therefore, assessed the epidemiological characteristics of snakebite cases, their management, and how antivenoms are utilised at the selected hospital in the Jasikan District Hospital. Methods: A 6-year retrospective study using secondary data from antivenom return forms (pharmacy records), clinical records (patient folders), the District Health Information Management System-2 (DHIMS-2) database, and consulting room registers was carried out in selected hospitals in the Jasikan District, Oti, Ghana. Results: The predominant symptom of snakebite was localised pain (71.4%). The snakebite commonly occurred at home (19%) and on farms (18%). Of the 98 snakebite cases, ASV was administered to 73 (74.5%) cases. Supportive treatment applied included prophylactic antitetanus immunoglobulin (ATS) (80.6%), prophylactic antibiotics (63%), corticosteroids (80.6%), and analgesics (63%). 95% (n = 94) of complete recoveries were recorded; three were discharged against medical advice, and one was mortality. The supply and use of antivenom were erratic throughout the months of high incidence, partly due to inconsistent availability at the Regional Medical Stores. The average ASV vials and hospital stay duration were 1.23 ± 0.86 vials and 2.67 ± 1.97 days, respectively. Although the peak of snakebites occurs in April, May, and June, the demand for antivenom in April and May exceeded supply. Conclusion: The outcome of most snakebite case management was appropriate, irrespective of inadequate ASV supply in certain months. The erratic antivenom supply should be aligned with seasonal and facility-use patterns to enhance regional snakebite management.

Retrospective study of tetanus in 18 dogs-Causes, management, complications, and immunological status.

Tetanus is a severe neurologic disease caused by Clostridium tetani, resulting in spastic paralysis. Canine tetanus is associated with serious complications such as aspiration and a high mortality rate of up to 50%. Medical records of all dogs diagnosed with tetanus over 8 years (2014-2022) were analyzed for severity grade, treatment protocols, nutritional management, and complications, as well as outcome, vaccination, and antibody production in some dogs. No medical records were excluded. Normality was analyzed by the D'Agostino-Pearson test. Parametric, normally distributed data were presented as mean ± standard deviation. Non-parametric, non-normally distributed data were presented as median (m) and range (minimum-maximum). The association between tetanus grade, progression of diseases, and duration of hospitalization was analyzed using the t-test, Mann-Whitney U test, and Kruskal-Wallis test. A P ≤ 0.05 was considered significant. Eighteen dogs were identified. Most affected dogs were classified into severity grade II (66.7%, 12 of 18). Clinical signs deteriorated in 55.6% of dogs (10 of 18). A source was identified in 88.9% of dogs (16 of 18). Nine dogs required surgical wound revision. A percutaneous endoscopic gastropexy tube was placed in 83.3% of dogs (15 of 18) for nutritional support. Medical treatment included metronidazole, methocarbamol, and combinations of different sedatives adapted to the patient's requirements. Tetanus antitoxin was used in 72.2% of dogs (13 of 18) without reported adverse events. The survival rate was 88.9% (16 of 18). Complications, such as hypertension, aspiration pneumonia, and laryngeal spasm occurred in 12 of 18 dogs. Median hospitalization time (8 days; range 0-16 days) was associated with the maximum tetanus severity grade (p = 0.022). Rapid eye movement behavior disorder was observed in 72.2% of dogs (13 of 18). In 5 dogs, antibodies were measured after recovery, and in 4 of 5 dogs, no antibodies were detectable despite generalized tetanus disease. Vaccination with tetanus toxoid was performed in five dogs following the disease. In the present study, the mortality rate was lower than previously reported. Tetanus is still a life-threatening disease, but the prognosis may be good if adequate management and monitoring can be ensured.

A case of tetanus in a previously immunized person

Tetanus is an acute infectious disease of humans and animals caused by anaerobic wound bacteria. The nervous system structural damage caused by toxin of the pathogen leads to tonic tension of the skeletal muscles and periodic generalized convulsions. If proper medical care is not provided in time, tetanus ends fatally. The incidence of tetanus is relatively low due to the widespread vaccination, but this infection can also occur in previously immunized individuals. The infection is widespread mainly in countries with a low economic level and weak health system. The tetanus poses a risk for all population segments, but the newborns and pregnant women are most vulnerable. Accor­ding to the Center for Public Health, 14 cases of tetanus were registered in Ukraine in 2022. The clinical picture of tetanus, as defined by the World Health Organization, includes painful muscle contractions, risus sardonicus (persistent spasm of facial muscles) and trismus (inability to open the mouth). Such patients have a history of trauma or damage to soft tissues, skin or mucous membranes. However, tetanus is a disease with multiple lesions, because in addition to the nervous system, the cardiovascular, respiratory and other systems are involved in the process. In the treatment, it is important to promptly introduce specific human tetanus immunoglobulin, perform debridement, antibiotic therapy and situational therapy. However, it should be borne in mind that the most effective and important direction is tetanus vaccination. The article presents a clinical case of tetanus in an 18-year-old pre-immunized patient who was admitted to a district hospital as a result of an injury. The purpose of publishing this case is to remind physicians to be alert for tetanus. In addition, the authors wanted to emphasize the risk of developing the disease even in previously vaccinated patients. The presence of prior vaccination and a high level of antitoxic antibodies cannot rule out a diagnosis of tetanus.

Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study.

Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.

Epidemiological pattern and management of dog bite injuries in Karachi, Pakistan: A cross-sectional study

BackgroundDog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. MethodsWe conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. Results2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. ConclusionThere is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury.

Assessment of the magnitude and contributing factors of expired medicines in the public pharmaceutical supply chains of Western Ethiopia

BackgroundThe magnitude of expired medicines in supply chains are increasing globally due to lack of strict control of the supply chain, poor storage management and oversupply of medicines. This situation is very serious in resource-poor countries, including Ethiopia, where the supply of medicines is limited. Therefore, this study aimed to assess the magnitude and the contributing factors of expired medicines in the Public Pharmaceutical Supply Chains of Western Ethiopia.MethodsExplanatory sequential study design involving mixed quantitative and qualitative approach were employed among 62 public pharmaceutical supply chains of Western Ethiopia from July1 to August 30, 2021. An observational checklist and the self-administered questionnaire were used to review all records of the expired medicine file and to abstract secondary data on the extent, types of expired medicines and its contributing factors. The collected data was cleared, filtered, and coded using Microsoft Excel® 2010, and exported to SPSS version-23 (Amsterdam, Netherland) for statistical analysis. Bivariate logistic regression was used to check association between the outcome and independent variables. Multivariate logistic regression was analyzed when p-value is less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical at p-value < 0.05. Moreover, audio recordings were transcribed and coded for emergent themes using thematic analysis.ResultsThe study revealed 5% expire rate over past two financial (2012 up to 2013) years and the total amount of expired drugs is estimated at 20 million Ethiopian Birr (ETB). Tetanus antitoxin (TAT), in terms of single drug value, had the highest drug expiry (4,110,426.43ETB: 20%), followed by liquid dosage forms (11,614,266.11 ETB: 57%). The Binary logistic regression result indicated that, poor store management were more likely associated with the magnitude of expired medicine than those with good store management (COR: 10.706, 95% CI: 2.148, 53.348). Multivariate logistic regression revealed that poor store management (AOR: 9.718, 95% CI: 1.474, 64.082) was a significant contributor to the expire rate at 5% (P < 0.05). Most facilities did not have a procedure, and programme for disposing of expired medicines. According to key informants, inadequate inventory management, lack of policy and implementation of standards are the main contributing factors of the medicine's expiration.Conclusion and recommendationsThe current study found that the overall rate of medication expiration is high, at a significant cost to the budget. Inadequate inventory management, lack of policy, and implementation of standards are the main contributing factors to the medicine's expiration, as cited by key informants. Further research is necessary to determine the quality and efficacy of these expired drugs to extend their shelf life to ensure adequate access to drugs in resource-limited settings.

In-Hospital Mortality among Patients of Severe Adult Tetanus Presenting with bad Prognostic Factors: A Tertiary Care Hospital Experience

Background: Tetanus caused by clostridium tetani, despite being a preventable disease, is still posing a significant health hazard to developing countries like Pakistan. Objective: To determine in-hospital mortality among patients of severe adult tetanus presenting with bad prognostic factors.Material and Methods: This cross-sectional study was conducted at the Department of Medicine, Medical Teaching Institution Lady Reading Hospital, Peshawar, Pakistan from July 13, 2017, to January 13, 2018, on 176 patients. All severe adult tetanus patients as per Ablett Classification with bad prognostic factors (incubation period &lt;7 days, persistent fever &gt;40o C, persistent tachycardia of &gt;120/min, and no history of post-exposure prophylaxis) were included in the study. Patients with compromised renal functions (urea &gt;108 mg/dl, reduced urine output &lt;50 ml/hr) and already diagnosed neuromuscular junction disorders were excluded from the study. Written informed consent was obtained and patients were enrolled in the study. All patients were immediately worked up with detailed history and clinical examinations and were managed as per ICU protocols and followed within the hospital for mortality.Results: Mean age of study participants was 47±10.27 years. The majority of study subjects were males (n=102, 58%), un-immunized (n=88, 50%) or partially immunized (n=26, 15%), socioeconomically poor (n=84, 48%), illiterate (n=82, 47%) and from urban areas (n=114, 65%). In-hospital mortality was recorded in 109 (62%) of the study subjects. In hospital mortality was recorded highest in patients with an age range of 41-65 years (n=70/109, 64.22%), males (n=63/109, 57.8%), unimmunized (n=55/109, 50.45%), poor (n=52/109, 47.7%), illiterate (n=51/109, 46.78%) and urban (n=71/109, 65.14%). Conclusion: In-hospital mortality was high in patients with severe adult tetanus presenting with bad prognostic factors.Keywords: Clostridium tetani, Hospital Mortality, Severe adult tetanus, Tetanus, Tetanus Antitoxin, Tetanus Toxoid, Trismus, Prognostic Factors.

Cognition about emergency management of avulsed incisor in children among dentists in Guangdong province.

This study aimed to evaluate and analyze the current situation of dentists in Guangdong pro-vince regarding the management of avulsed incisors, thereby providing a reference for making treatment strategies for avulsed incisors in the future. A total of 712 dentists with different educational backgrounds and working conditions in Guangdong province were randomly selected to conduct an online questionnaire survey on the cognition of children with avulsed incisors from April 2022 to May 2022. The data were recorded by Excel software and statistics were analyzed on Stata/SE 15.1. A total of 712 dentists were investigated and 701 questionnaires were collected (98.46%). In addition, 65.9% of investigators came from the Department of Stomatology in a First-class Hospital or Stomatological Hospital. The results showed that the average number of avulsed teeth consulted by dentists was less than 20 per year. Although 99.7% of respondents considered normal saline as a suitable storage medium, 3.1% and 23.8% of them had a misunderstanding that the tap/alcohol could be used for root cleaning. Moreover, 93.4% was the correct selection rate of the treatment plan for processing on root surfaces before replanting by investigators. The correct selection rate of the duration using elastic fixation was only 10.7%. Meanwhile, 42.9% of investigators refused to inoculate tetanus immunoglobulin after teeth replanting. Emergency management of dental avulsion (EM) and clinical management of dental avulsion (CM) answered correctly with average scores of 14.60±11.85 and 14.48±2.67, respectively. Multivariate linear regression analysis revealed that working years were negatively correlated with EM and CM scores (P<0.05). There was a positive correlation between CM and EM scores with the number of avulsion cases treated by physicians each year (P<0.05). In terms of the EM score of dentists' learning attitude, investigators who had received enough knowledge were higher than those who had not and insufficient knowledge reserved, and the difference was statistically significant (P<0.05). The scores of investigators who thought they had a certain degree of knowledge about dental trauma were higher than those who thought they "did not understand", and the difference was statistically significant (P<0.05). In terms of CM scores, investigators who thought the knowledge of dental trauma was "very helpful" had higher scores than those who thought it was "not helpful", and the difference was statistically significant (P<0.05). The scores of the investigators who thought they had "relatively sufficient knowledge" of dental trauma were higher than those who thought they had "no knowledge" or "insufficient know-ledge", and the difference was statistically significant (P<0.05). The overall accuracy of the management of avulsed incisors among dentists was low in Guangdong province. Dentists were more likely to have a higher rate of accuracy choice in treatment options for luxation injury and avulsion to enhance the prognosis of replanted teeth.

Postoperative tetanus in abdominal surgery: scope review

Postoperative tetanus is a rare, often forgotten, but potentially fatal complication of abdominal surgery. The purpose of this paper is to review the available literature on postoperative tetanus following abdominal surgery, including its incidence, risk factors, clinical features, management, and outcomes. A comprehensive search of the PubMed, Embase, Scopus, Lilacs, and Google Scholar databases was conducted using relevant keywords (“Tetanus,” “abdominal surgery,” “Postoperative”), and a total of 1.182 articles were identified for review, with 11 being selected. The incidence of postoperative tetanus following abdominal surgery is very low, with only a few case reports published in the literature. Most cases occurred in patients with risk factors such as chronic alcoholism, diabetes, and malnutrition. The clinical presentation of postoperative tetanus can be variable, ranging from mild symptoms such as muscle stiffness and spasm to severe features such as respiratory failure and cardiac arrest. The diagnosis of postoperative tetanus is primarily clinical and is based on characteristic symptoms and signs. Treatment involves prompt administration of tetanus immunoglobulin, wound debridement, and supportive care. In conclusion, postoperative tetanus following abdominal surgery is a rare but severe complication that requires immediate recognition and management. Clinicians should be aware of the risk factors for tetanus and take appropriate preventive measures, such as preoperative vaccination, in high-risk patients.

Safety of equine tetanus antitoxin for prophylactic use in Ethiopia: a retrospective multi-center study

BackgroundTetanus remains a severe life-threatening infectious disease and neurological disorder in many parts of the world, where immunization programs are suboptimal. Any human injury or trauma has the possibility of getting infected with Clostridium tetani which is the sole causative bacterium of tetanus. Evidence is available that TAT may cause anaphylaxis and late serum sickness, while there has been no study conducted in Ethiopia. The Ethiopian Ministry of Health standard treatment guideline recommends tetanus prophylaxis for all tetanus-prone wounds. This study aimed to evaluate the safety of TAT administration in adults exposed to tetanus-prone wounds in Ethiopia.MethodsThe target product of this study was the equine tetanus antitoxin developed and manufactured by the ViNS Bioproducts Limited, India (Code: 130202084, A.W.No: 15/AAW/PI/02.00, DT: 25.04.2016). The product is delivered with the dose of 1000/1500 IU intramuscularly or subcutaneously to individuals at risk of tetanus infection for prophylactic purposes. The study was carried out in 11 healthcare facilities in Addis Ababa, Ethiopia, that had a relatively high clients load for tetanus-prone wounds. Medical records of patients with tetanus-prone wounds who received the equine TAT were reviewed retrospectively for any adverse events following immunization according to the World Health Organization (WHO) definition for adverse events following immunization (AEFI).ResultsThere were more than 20,000 patients treated for trauma in the facilities from 2015 to 2019. Upon revision of available registration books, we identified 6000 charts to be eligible for the study, of which 1213 charts that had complete and reliable data on the AEFI profile of the TAT were included in the final analysis. The median age of the study participants was 26 years (IQR = 11 years, age range: 18–91 years) and 78% (949) were male. The tetanus-prone wounds resulted mainly from stab (44%, 535) and blunt force (30%, 362), and the most common sites of wounds were hand (22%, 270) and head (21%, 253). The most and least frequently occurring types of wounds were open wounds (77%, 930) and organ system injury (0.003%, 4), respectively. The mean time of presenting at health facilities from the onset of trauma was 2.96 h. Of the total 1231 participants, one male participant who presented within 3 h after experiencing a wound on his nose at the workplace had a severe local reaction immediately after injection of the TAT. No AEFI was recorded for the other participants.ConclusionsThe adverse event following immunization of the equine tetanus antitoxin produced by the ViNS Bioproducts Limited was very rare. A regular review of the product’s safety performance and systematic collection and analysis of adverse event reports are important to ensure the safety of the product.

脂漏性角化症が侵入門戸と考えられた破傷風の1例(A case of tetanus in which the portal of entry was presumed to be seborrheic keratosis)

要旨87歳の男性が開口障害，嚥下困難のため経口摂取不能となり，他院に入院した。入院後から徐々に刺激による下肢の痙攣，筋緊張が出現し，気道閉塞による一過性の呼吸停止があり，当院へ転院搬送された。破傷風と診断し，破傷風トキソイド，破傷風免疫グロブリン，ペニシリンGを投与し，人工呼吸器管理および筋弛緩薬，鎮静薬，鎮痛薬，マグネシウム製剤などで全身管理を行った。明らかな外傷はなかったが，右前胸部の脂漏性角化症に浸出液を認めたため培養に提出したところ，Clostridium tetaniが検出され，腫瘤を切除した。経過は良好であり，気管切開孔を閉鎖し，リハビリ継続目的に転院した。脂漏性角化症が侵入門戸となって破傷風を発症した症例は，過去に報告されていない。破傷風は本邦では高齢者に多い疾患であり，高齢者には脂漏性角化症がほぼ必発である。また破傷風の治療においては，侵入門戸を検索し，必要があれば処置を行わなければならない。したがって，高齢者にごくありふれた疾患である脂漏性角化症が，Clostridium tetaniの侵入門戸となりうるということを，救急医が認識することは極めて重要と考える。