Search

We present a case of a 51-year-old immunosuppressed man with underlying chronic lymphoproliferative leukaemia (CLL), who presented to us in emergency with breathlessness, hydrophobia, anxiety and restlessness. He had a history of category 3 dog bite 2 months ago and had received a full course of rabies immunoglobulin and antirabies vaccine (ARV) as per the national schedule. As there were frank clinical reports of rabies, the patient was managed according to Milwaukee regimen. The patients died within a week of the appearance of symptoms. The brain autopsy revealed Negri bodies conforming the mortality due to rabies.Immunosuppressed patients, like our patient who had CLL have low antibody formation after rabies prophylaxis. Antibody titres in immunosuppressed patients need to be measured after the 2–4 weeks of the last injection of ARV to decide whether a booster of ARV needs to be administered or not.

Context: Rabies remains a public health challenge in many parts of the world with over 90% of human rabies cases worldwide attributed to dog bites. In India the annual incidence of dog bite is 1.9%. The study was conducted to analyse the distribution of dog bite cases as per time, place and person. Methodology: A cross-sectional study was conducted between Jan-2016 and Dec- 2017. A total of 228 victims of dog bite were interviewed. They were selected using systematic random sampling technique. Data was analysed using SPSS. Spot maps were prepared. Results: The proportion of adults being bitten by dog was more than that of children. Most of the bites occurred after evening hours. There was similarity in the place of residence and place of occurrence of bite in 81% of the cases. A statistically significant association was seen between the type of occupation and place of occurrence of dog bite. Conclusion: Epidemiological mapping of dog bite cases gives more insight to understand the problem and aids in planning control measures against occurrence dog bite. Most dog bites occurred at hours when the man dog interaction was highest. The individuals working in outdoor type of occupation are at high risk for dog bite.

Management of soft tissue avulsion after facial bites could be challenging in some situation. We presented the case of a 32 years old men suffering from a full thickness avulsion of the left lower lip and cheek after a dog bite. Even if the lip fragment was initially put on the bin, a microvascular replantation was performed. The vascularization was based on the left inferior labial artery. No veins were found. We used post-operative leech therapy to avoid venous congestion during 10 days. A large antibiotherapy was conducted. Adaptation of antibiotics blood concentration was also necessary due to the permanent bleeding caused by leech therapy. At the 6 month consultation, the patient recovered an impressive labial function and sensibility. Replantation gives the best functional and esthetical outcomes in these rare and complex cases. Artificial blood drainage, large antibiotic therapy and close post-operative follow-up are significant parts of the replantation success.

Facial trauma accounts of 7% to 10% of emergency department visits in the United States every year. The management of facial soft tissue trauma is an essential skill for the facial plastic surgeon. Understanding preoperative evaluation, repair/management of concomitant injuries, postoperative care, and scar treatment help the facial plastic surgeon obtain the best functional and aesthetic results for the patient. Treating the face by subunit and avoiding common pitfalls is the key to achieving optimal results. This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma.

CASE DESCRIPTION A 12-year-old 32-kg neutered female crossbreed dog was treated for a large lumbosacral skin defect. CLINICAL FINDINGS The dog had sustained multiple, penetrating dog bite wounds to the lumbosacral and gluteal regions 5 days earlier. The referring veterinarian had initiated treatment with amoxicillin–clavulanic acid, which was continued at a dosage of 8.75 mg/kg, SC, every 24 hours at the referral hospital. Examination of the skin defect revealed a large subcutaneous abscess in the dorsal lumbosacral region with draining perimeter tracts at the wound margin. The partial-thickness wound measured 24 × 35 cm and had multifocal regions of necrosis extending caudally from the dorsal aspect of the T11 vertebra to the tail base. The skin defect was bounded by discolored and necrotic skin edges. TREATMENT AND OUTCOME The dog underwent extensive soft tissue wound reconstruction. A single, large, meshed full-thickness free skin graft was harvested from the left dorsolateral aspect of the thorax and grafted to the dorsal lumbosacral region, thereby enabling successful closure of the wound defect. Primary healing of the wound eventually occurred, without postoperative complications. CLINICAL RELEVANCE Use of a large, meshed full-thickness free skin graft led to a satisfactory outcome for this dog but required challenging postoperative management. Application of single, large, meshed full-thickness free skin grafts may be an option to manage large skin deficits in the lumbosacral area in dogs.

Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.

Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016–2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.

Introduction: Rabies, though endemic in India, has been a disease of low public health priority throughout the years. Being a non-notifiable disease together with limited diagnostic facilities, it often ends up in under-reporting of cases, especially atypical rabies. Failure of complete rabies Post Exposure Prophylaxis (PEP) with Immunoglobulin has been rarely reported. Case: We report a case of atypical rabies in a 60-year-old man from a rural village in Kerala, who presented with fever, paralysis of limbs, fluctuating consciousness, phonophobia and without classical signs of hydrophobia and aerophobia 22 days after dog bite. The case is supplemented with supportive Magnetic Resonance Imaging (MRI) findings and corneal imprint smear Fluorescent Antibody Test (FAT). The death of the patient on the 28th day of exposure despite early PEP with rabies vaccine and immunoglobulin is suggestive of PEP failure. Conclusion: The case study stresses on the need in making rabies a notifiable disease in the study setting, encouraging disease specific investigation, ensuring availability of vaccine and immunoglobulins with adherence to standardized treatment protocols. Key Messages: Deviations from the recommended protocol for Animal bite management, such as delay in seeking PEP, lack of or improper administration of rabies immunoglobulin (e.g. missing out bite sites), lack of or improper primary wound care, and/or poor-quality rabies vaccine, may lead to death. Keywords: Atypical rabies, Death, Post exposure prophylaxis failure, Zoonosis

Child safety around dogs is a serious public health concern, in particular in countries where free-ranging dogs and dog-mediated urban rabies are an issue, such as Turkey. The present study is the first to investigate the effectiveness of a dog bite prevention programme in pre-school children in Turkey. In this study, pre-school students aged between 3 and 6 years (N = 117) received an interactive education programme. The programme consisted of an interactive oral presentation, a drama session (“Being a Tree”), and a practical session, i.e. meeting a dog. Two different questionnaires were administered to children before (PrE), immediately after (PE0), and one week after the programme (PE1): (i) the Dog-Human Interaction questionnaire and (ii) the Contexts for Approaching Dogs questionnaire. Significant improvements in the scores in both questionnaires were found between the evaluations before and after the education. Moreover, older students had significantly higher scores in both questionnaires during PE0 and PE1. The majority of the students were found to be successful in the evaluation of the “Being a Tree'' concept during PE0 and PE1. The results of this study show that the interactive dog bite prevention program can increase the awareness and knowledge of pre-school children on dog behavior. Findings also suggest that age should be considered when designing a dog bite education program. As being a tree concept can be learned by children from all age groups, it can be a useful and beneficial component of dog bite prevention programs in countries having a big population of free-ranging dogs.

Introduction: Dog bites are a significant health concern in the pediatric population. Few studies published to date have stratified the injuries caused by dog bites based on surgical severity to elucidate the contributing risk factors. Methods: We used an electronic hospital database to identify all patients ≤17 years of age treated for dog bites from 2013–2018. Data related to patient demographics, injury type, intervention, dog breed, and payer source were collected. We extracted socioeconomic data from the American Community Survey. Data related to dog breed was obtained from public records on dog licenses. We calculated descriptive statistics as well as relative risk of dog bite by breed. Results: Of 1,252 injuries identified in 967 pediatric patients, 17.1% required consultation with a surgical specialist for repair. Bites affecting the head/neck region were most common (61.7%) and most likely to require operating room intervention (P = 0.002). The relative risk of a patient being bitten in a low-income area was 2.24, compared with 0.46 in a high-income area. Among cases where the breed of dog responsible for the bite was known, the dog breed most commonly associated with severe bites was the pit bull (relative risk vs German shepherd 8.53, relative risk vs unknown, 3.28). Conclusion: The majority of injuries did not require repair and were sufficiently handled by an emergency physician. Repair by a surgical specialist was required

Animal bites are a significant cause of morbidity and mortality across the globe and when involving the orofacial region, they commonly present to dental surgeons. Literature on their initial management provides a plethora of conflicting views and results and it is necessary to be up to date with the latest modalities of management of such facial injuries to give best functional and surgical outcomes to the patients. Antibiotics and anti-tetanus and anti-rabies vaccinations and immunoglobulins should be judiciously administered along with appropriate wound management.

Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.

Introduction: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. Dog bites in human are a serious public health problem and have been well documented worldwide. As rabies is not a notifiable disease in Bangladesh and most deaths occur in rural areas where surveillance is poor. Objectives: To determine the pattern of dog bite injuries and associated health problems among children. Methods: The study was an observational retrospective study carried out at the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh. The study reviewed the clinical data of patients managed for dog bite related injuries and rabies over a four and half year period between January 2016 and June 2020. A proforma was designed to extract relevant clinical data from the case records. Information extracted included the age, sex of the victims, site of the bite, time of presentation in the hospital, pre-hospital treatment, hospital treatment including post-exposure prophylaxis and complication. Results: In all, 200 cases of dog bite injuries were managed constituting 0.89% of the total consultations; 5 (2.5%) had rabies. Most of the victims were aged 6-12 years (55.0%) and majority (67.0%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. 92 (46.0%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (56.0%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 95.0% received anti-rabies vaccine, only 55.5% of them completed the vaccination schedule. The case fatality rate for dog bite was 5.0%. The 5 that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: There is need for public enlightenment on dangers associated with dog bites and also for the government to ensure vaccination for cost of post exposure prophylaxis treatment for children free of cost

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known:• Dog bites are a substantial healthcare problem especially in children. What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.

An immature canine was attacked by another dog in a kennel facility and sustained multiple wounds to the lateral right forelimb and cranial right lateral thoracic region. General surgical and antimicrobial therapies were instituted immediately. The patient battled with recurrent infections and subsequent delayed healing. After approximately 35 days from the initial injury, the patient became acutely lame and febrile. The persistently open wounds were cultured and returned positive for Salmonella spp. Within the following days, the patient became painful, and the lameness progressed significantly. Radiographs confirmed pathologic humeral fracture, and the patient was referred for specialty evaluation. Zoonotic preventative protocols were adopted at the specialty facility upon arrival. Complete forequarter limb amputation was curative in this patient., An immature canine was attacked by another dog in a kennel facility and sustained multiple wounds to the lateral right forelimb and cranial right lateral thoracic region. The patient battled with recurrent infections and subsequent delayed healing and after approximately 35 days from the initial injury, the patient became acutely mildly lame and febrile. Open wounds and draining tracts were cultured and returned positive for Salmonella spp.; within the following days, the patient became painful, and the lameness progressed significantly, with radiographic confirmation of a pathologic humeral fracture.

Background Ethiopia accommodates the second largest number of human rabies deaths in Africa. This systematic review and meta-analysis aimed to summarize and pool estimates of dog-mediated rabies status in Ethiopia. Methods Published researches between 2010 and 2020 were comprehensively searched and the required information was extracted. The prevalence was estimated using the random-effects meta-analysis because higher heterogeneity between studies was expected. Results The pooled estimate of rabies was 32% (95% CI: 19–46%), with individual study prevalence estimates ranged from 1 to 78%. Studies were approximately weighted equally with individual weight ranging from 5.19–5.28%. Subgroup analysis indicated that the random pooled prevalence of rabies was 28% (95% CI: 0–81%) in animals and 33% (95% CI: 20–47%) in humans. Furthermore, a subgroup analysis across regions indicated that the pooled prevalence was 78% in Addis Ababa, 46% in Oromia, 40% in Tigray and 5% in Amhara regional states. No single study was reported from the country’s eastern and southern parts to be included in this meta-analysis. Conclusion The estimated pooled rabies prevalence was found high and showed varying among study regions. Therefore, focusing on mass dog vaccination campaigns and public awareness should be implemented to control the disease.

Dogs are the animal most frequently implicated in causing bite injuries to the human face. Dog bite injuries are most prevalent in younger patients. Pasteurella species are commensals of the oral microbiome of dogs and cats and are frequently implicated in infections resulting from dog and cat bite injuries. HIV, hepatitis B, and hepatitis C need to be considered in bites inflicted by humans. All animal bite wounds should be washed out. Most animal bite injuries can be managed in an outpatient setting. Given the cosmetically sensitive nature of the face, bite wounds generally merit suturing, even in delayed presentations.

CASE HISTORIES Medical records of a veterinary hospital in Belgium were reviewed for dogs (n = 5) that presented between 2016 and 2019 with laryngeal paralysis secondary to bite wounds to the cervical region received while fighting with other dogs. The time elapsed between the trauma and presentation was from a few hours up to 5 days. CLINICAL FINDINGS AND TREATMENT Bilateral laryngeal paralysis was identified in three dogs and unilateral laryngeal paralysis in two dogs via endoscopic assessment of laryngeal function. The primary concomitant lesions included tracheal injury in 3/5 dogs and oesophageal injury in 1/5 dogs. One dog with bilateral laryngeal paralysis was treated medically as no signs of dyspnoea were present. Surgical management was elected in 4/5 dogs based on evaluation of their clinical status and lesions revealed by endoscopic examination of upper gastrointestinal and respiratory tracts. Dogs underwent surgical procedures that were determined to be appropriate for treatment of the lesions identified on clinical examination, diagnostic imaging, and endoscopy. The cervical region was explored through a ventral midline approach in 2/4 cases, to close tracheal perforations. Temporary tracheostomy was performed in 2/4 cases. Procedures to correct brachycephalic airway obstructive syndrome were performed in 2/4 cases. Cricoarytenoid lateralisation was performed in 2/4 dogs. Dogs were hospitalised for 2-10 days and received antimicrobial therapy before surgery and for 2-3 weeks after surgery. Physical examination and respiratory function were normal in 3/5 dogs 4-6 months after discharge. Information regarding outcomes for two cases was obtained from the owners by telephone assessment 1-6 months after surgery. The owner of each dog reported the respiratory function to be excellent. DIAGNOSIS Uni- or bilateral, transient or permanent laryngeal paralysis with concomitant oesophageal, tracheal, or laryngeal lesions following cervical dog bite injuries diagnosed by endoscopic examination of upper gastrointestinal and respiratory tracts. CLINICAL RELEVANCE This case series describes the diagnosis and management of dogs with laryngeal paralysis secondary to cervical dog bite injuries. To the authors' knowledge, this is the first published report documenting bilateral laryngeal paralysis secondary to cervical dog bite injuries. Clinicians should be aware of this pathology and the importance of investigating laryngeal function in dogs presenting with cervical bites, particularly those with inspiratory dyspnoea. Upper airway and digestive endoscopy are recommended for complete assessment of cervical traumatic injuries.

A 10-year (2008-2017) retrospective canine-mediated human rabies epidemiology was studied to assess the burden of rabies in Nepal. To this end, the number of dog bites, the use of post-exposure prophylaxis (PEP), and human death records from 2008 to 2017 were retrieved from Sukraraj Tropical Hospital, Kathmandu, Nepal. The findings revealed that the number of human rabies occurrences was consistent with minor fluctuations throughout the study period. There were 252,297 dog bite cases in humans recorded between 2008 and 2017. Every month, 2,102 people were bitten by mostly stray dogs. There was a gradual increase in PEP use throughout 10 years. On average, 36,995 PEP dosages were used per year for stray dog bites. The PEP consumption and the number of human deaths were negatively correlated. A total of 482 human rabies deaths were recorded in Nepal during the study period. On average, 49 people died of canine-mediated rabies each year. Although there was an increase in the use of PEP, the number of human deaths and street dog bites recorded were still high. The high mortality due to rabies could then be attributed to the flawed surveillance system and stray dog population management, and not merely the lack of PEP services. Hence, it is recommended that the government agencies and other concerned stakeholders should organize mass vaccination and population management program for stray dogs in order to reduce the country’s rabies burden.

Background: Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management. Objectives: Investigate the effectiveness of amoxicillin–clavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns. Materials and methods: In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin–clavulanic acid (group A) or amoxicillin–clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups. Results: Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin–clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin. Conclusion and clinical significance: Amoxicillin–clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.

Dog bite cases pose a major public health threat in Nigeria and other nations of the world. Millions of people are bitten by dogs, and most cases are fatal when bitten by rabid dogs. This study evaluated dog bite cases in Umuahia, Abia State, Nigeria. It is a retrospective study on the clinical records of dog bite patients managed between 2016 to 2018 at the Federal Medical Centre Umuahia. Out of 98 reported cases of dog bites, there was a higher incidence rate of (65.3%) among the male victims than females (37.7%). 19.4% of the cases were victims of less than 15 years of age. Lower limb (59.2%) was the major site of bite cases. 58.2% of the offending dogs were owned while 41.8% were stray dogs. Only 31.6% of offending dogs had up-to-date anti-rabies's vaccination. Clinic records showed that 52% of the patients werepresented within 24hrs of the incidence at the hospital. Use of herbal balms (48%) was the most pre-hospital treatment received by dog bite victims. 4 victims had confirmed rabies case. Wound sustained by victims included open wound, lacerations, bruises and avulsion. Treatment pattern was based on evaluated risk of exposure of victims. In conclusion, dog bite cases in this study occurred more in malesand adults with mostly owned dogs being involved in the reported cases. Most victims of dog bite cases at the Centre promptly presented their cases for medical consultation. Public awareness is required on the need to avoid provocative dog bites, prompt hospital visitation when bitten by a dog, and there is a need for dog owners to vaccinate their dogs annually against rabies. Keywords: Appraisal, Dog- bite, rabies,treatment-regimen, Umuahia

Depressed skull fractures from dog bites are common pediatric head injuries which are contaminated with native skin and canine oral flora. Outcomes can potentially be catastrophic. Thus, these injuries require proper initial management to prevent future complications. We present an 18-month-old female who was bitten by a Great Dane dog and resulted in a small left temporal depressed skull fracture with an underlying brain contusion. This was initially treated conservatively with antibiotics and bedside irrigation. Five weeks later, she developed a large multiloculated abscess with mass effect, which required surgical aspiration and wound debridement. After long-term antibiotics, she made a full neurologic recovery. Our case illustrates the importance of washing out a seemingly inconsequential depressed skull fracture from a dog bite to avoid development of a cerebral abscess.

Background Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center. Methods This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed. Results Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair. Conclusions Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction.

Background Rabies, a neglected tropical disease (NTD), is a viral infection which is often fatal. Since 2017, a rabies epidemic has been declared in Sarawak, Malaysia. However, there is a lack of local epidemiological data and descriptions of local presentations of this disease. Method This was a retrospective analysis of a series of rabies cases encountered in Sibu Hospital, Sarawak from March 2020 to February 2021. Result Six cases of rabies were identified in this series, all with a mixture of upper motor neuron and lower motor neuron findings. Most cases did not seek medical attention upon dog bite and therefore effective post-exposure prophylaxis was not given. The incubation period varied from 17 days to 2 years. All cases died, with five cases succumbing to the illness within two weeks of symptom onset. The cumulative incidence for rabies in Sibu was estimated at 1.7 per 100,000 population. Conclusion The lack of public awareness of the implication of animal bites and the immediate management in rabies-endemic regions are factors contributing to high rabies mortality.

Dog bites are a serious public health concern internationally and children are often at particular risk of them. Because bites to children often occur during apparently benign interactions with a parent present, the need for dog-bite prevention approaches to address adults’ awareness of, and supervision of, child–dog interactions has been highlighted. The aim of this study was to evaluate a hazard perception test of potential dog-bite hazards within a home setting. Six hazards were incorporated in a 2-minute 41-second video, which was embedded into a web-based interface that enabled respondents to identify hazards by clicking the mouse button or tapping the screen of a tablet computer as the video played. The 268 volunteer respondents also completed a short questionnaire. These respondents were predominantly female and appeared more likely to have undertaken higher education and have greater experience with dogs than the general population. Almost one-third (31.8%) of respondents identified all six hazards, and a further quarter (24.5%) missed only one; a quarter (25.2%) identified 3 or fewer; and 43.8% identified 4 or fewer hazards. No one scored zero, and 5.5% and 6.9% identified 1 and 2 hazards, respectively. A range of factors was associated with the identification of specific hazards. Participants with professional or long-term experience with dogs and those with higher educational attainment were more likely to detect some hazards. Older respondents were less likely to identify several of the hazards, and those living with children were less likely to identify cuddling a dog as a hazard. We find that hazard perception testing could be a useful tool for the assessment of knowledge regarding dog-bite risk situations and potentially an educational tool for increasing knowledge and changing practices around dogs.

Background and Aim: Rabies is a fatal zoonosis caused by RNA virus belonging to genus Lyssavirus. Nepal is one of the endemic countries in South Asia for rabies. This study was conducted to better understand the knowledge, attitude, and practice (KAP) of Nepalese community toward rabies across five developmental zones of the country. Materials and Methods: The cross-sectional study was carried out by face-to-face interview using structured questionnaires among 5000 respondents of five cities representing each of the five developmental regions of Nepal by adopting random cluster sampling procedure. The respondents were classified into four categories, including gender, age, education, and social status. The responses for KAP variables were analyzed using descriptive and Chi-square test. Results: The male and younger age respondents with higher education and social status were found more knowledgeable than their counterparts in terms of knowledge variables, including cause of rabies, mode of transmission, clinical signs, treatment, and preventive measures of this fatal disease. Similar findings were observed for attitude and practice variables such as vaccination practice, dog sterilization, health-seeking behavior, first aid practice, and use of first aid materials after dog bites. Some respondents in elderly age group still preferred to use traditional and local methods, which were application of turmeric powder and shrubs to cure dog bites rather than seeking medical facilities. Conclusion: There is a strong need for rabies awareness programs in the community targeting females, school, and college-level students, older age groups, and economically marginalized communities. The awareness materials need to focus on particular topics such as the risk of rabies, modes of transmission, the importance of first aid, health-seeking behavior following dog bite injuries, and practice preventive measures for their pets and community dogs.

Animal bites cause a big burden worldwide in terms of morbidity and mortality. As per WHO, dog bites are the cause of major animal bite injuries followed by snake bites, cat bites, and monkey bites. Annually about 55,000–60,000 persons die of rabies, of which nearly one-third are from India alone. Rabies, though being a 100% fatal disease, is also a potentially preventable disease. Objective: To estimate the proportion of animal bites in patients attending anti-rabies clinic of a tertiary hospital, Mysuru. Material & Methods: A cross-sectional study was carried out during the period of June 2018 - May 2019. Secondary data was collected from the registers available at the anti-rabies clinic in KR Hospital, Mysuru, using a pretested proforma. This information was compiled in an excel sheet and analysed using simple measures like proportions, percentages, and graphs. Results: A total of 3861 animal bite cases were reported, out of which, 69.1% were males and 30.9% were females. Dog bites contributed the highest (92.1%) followed by cat bites (5.2%). As per the category of wounds, 59.6% were Category 2 and 36.2% were Category 3 wounds. Conclusion: Dog bite is the commonest animal bite which needs to be addressed as a priority with appropriate preventive strategies. There is a pressing need to create awareness among the general population about the need for timely health care seeking behaviour and to avail the benefit of free anti-rabies vaccination in the public health sector in order to prevent the risk of fatal events. How to cite this article:Suresh H, Ahmed M, Khan MA. Profile of Animal Bite Cases in a Tertiary Care Hospital in Mysuru. Int J Preven Curat Comm Med. 2021;7(1):25-30. DOI: https://doi.org/10.24321/2454.325X.202104

Craniofacial fractures from canine bites are rare, but can be devastating events that lead to complex surgical management, long-term functional deficits, and psychological sequelae. The objective of this case-control study was to identify risks associated with craniofacial fractures in pediatric dog bite victims. From 2008 to 2019 at our quaternary center, all children with craniofacial fractures from dog bites were included in this study. Controls were obtained in a 2:1 ratio via a random sample of all dog bite encounters. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Of 3602 dog bite encounters, 114 children were included in the study with an average age of 4.8 years (interquartile range = 2.4-9.1 years) and 51 patients (45%) were female. Seventy-four children (65%) were bitten by a family-owned dog. Thirty-eight patients with 60 craniofacial fractures were identified. The following factors were significantly associated with increased risk for craniofacial fractures: Caucasian race (OR 7.3, CI 1.6-16.7), age under five (OR 4.1, CI 1.6-10.7), rural location (OR 3.9, CI 1.3-12.3), child location on the floor (OR 6.2, CI 2.4-16.2), and dogs weighing over 30 pounds (OR 19.6, CI 5.8-82.3). Nine patients (12%) required multiple reconstructive operations, and four patients (5%) developed post-traumatic stress disorder. In conclusion, toddlers in rural households with large dogs are at high risk for sustaining craniofacial fractures from bite injuries. Craniofacial surgeons, pediatricians, and emergency department physicians should use these data to lead prevention efforts in the community.

Background: The Indian Association for the prevention and control of rabies estimates that 80, 00, 000 individuals receive the treatment for dog bites each year. The matter with dog rabies in India is that dogs are asymptomatic in each human establishment.

Objective. The study objective was to estimate the burden of human rabies in Ethiopia from 2015–2019. Study Design. A descriptive study design was applied to measure the size of the problem. Method. Retrospective data were used from the Ethiopian Public Health Institute rabies case record book that was registered between 2015 to 2019. Result. Eighty-seven (87) cases of human rabies were diagnosed clinically in the Ethiopian Public Health Institute over the period of five years (2015–2019) with 100% case fatality. Of these, 83 (95.4%) cases were attributed to dog bites, whereas 1 (1.1%) to a cat and 3 (3.4%) to wild animals. The fatalities were from Oromia (n = 51 (58.6%), 13 (14.9%) were from Amhara, 15 (17.2%) were from Addis Ababa, and 8 (9.2%) from the Southern region. All referred cases had no record of immunization against rabies except eight. Ineffective postexposure treatment was the reason for 5 (5.7%) deaths. Out of 1,652 brain samples of different animals, mainly dogs, submitted for examination, 1,122 (68%) were found to be positive for rabies by the FAT. Dog bites were more common among males than females. The number of dog bite victims who had visited the EPHI counseling office and recommended to take postexposure prophylaxis against rabies both from Addis Ababa and the surrounding areas were 9,592 and 4,192, respectively. Out of these, 5,708 were males and 3,884 females for the capital Addis Ababa. Similarly, 2,439 males and 1,753 females account for areas surrounding Addis Ababa. Among those exposed from Addis Ababa, 1,079 (11.2%) were in the age group less than five, 1696 (17.7%) were in the age group 6–13, and 6,817 (71.1%) in the age group 14 and greater. Victims from outside of the capital Addis Ababa account for 644 (15.4%) for the age group less than 5 years, 964 (23%) for the age group 6–13 and, 2,584 (61.6%) for the age group 14 and greater. Conclusion. Mechanisms must be sought to reduce the cost of PEP and means of obtaining funds so as to initiate timely treatment for rabies exposed individuals of low socioeconomic status. Besides prevention, strategies should focus on public education and strict dog population control.

Background Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission. Case presentation We report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs. Conclusion We present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.

Objectives To describe the clinical features and outcomes of a case series of adult tetanus and illustrate inadequacies in confronting this preventable disease. Design and Methods This study retrospectively evaluated 24 relatively severe, confirmed cases of tetanus, diagnosed between March 2017 and December 2018, in Kabul Antani Hospital, Afghanistan. Results Regarding the source of the infection: 18 patients (75%) had a history of injuries, 1 had a history of a dog bite and 1 was an intravenous drug user; 4 patients had no external injuries or wounds. Dysphagia was the main clinical manifestation for which patients sought medical treatment (50%). Of the 12 patients who died, 7 presented with confusion and seizure, 1 with acute kidney injury, and 2 with pneumonia. Conclusions Mortality due to tetanus is high in Afghanistan (Case Fatality Rate (CFR) 50%)), suggesting an urgent need for vaccination policy and programs, post-exposure protocols, and facilities equipped for the treatment of adult tetanus. The Ministry of Public Health of Afghanistan should seek to improve the accessibility, distribution and recording of tetanus immunization through vaccination.

Rabies is a fatal viral disease that affects all mammals. It causes an estimated 59,000 human deaths worldwide annually. Dogs are the main reservoir and transmitter of rabies to human in Sri Lanka. Prevention and control measures include the mass vaccination of dogs and human post-exposure treatment. While these measures appear to be homogeneous across the country, there is a need to identify community-level gaps due to the decentralization of regional health and veterinary services in conducting such activities. A community-based questionnaire survey was conducted to identify potential risk factors and gaps related to knowledge, attitudes and practices on rabies prevention and control in the rural regions of Sri Lanka. Lower knowledge scores were associated with respondents between 18 and 38 years old, had no experience of being bitten, and own semi-independent dogs. Despite associated fear of stray dogs with health issues, some communities provide shelter and/or food for the stray dogs. Uptake of population control and vaccination of dogs across the grama niladhari divisions (GNDs), which are the smallest administrative units, differed. More than 80% of dogs were not desexed and community knowledge on vaccination delivery, booster and vaccination schedules were also variable. Even though 69% of respondents identified stray/community dogs as potential carriers' owners allow their dogs to roam the neighbourhood. Most of the respondents were able to identify the need for post-exposure treatment after a dog bite. However, post-exposure prophylaxis uptake by the local victims ranged between 83.00% and 87.50%. Low participation was reported in health education in the communities. Lack of knowledge on other potential carriers was similar to previous survey studies in the last decade. Collaborations between local communities, veterinary and medical services are necessary to scale up the control programme in order to achieve the global target of zero rabies deaths by 2030. Further community-level studies are recommended.

Capnocytophaga canimorsus is a bacteria commonly found in the normal oral cavity of dogs that can cause bacteremia in immunocompromised patients following a dog bite. This case describes sepsis and disseminated intravascular coagulation associated with C. canimorsus in a patient with a history of alcohol abuse. Clinicians must be alert to the risk factors for this infection and provide appropriate prophylaxis following dog bites.

Introduction Lacerations and open elbow injuries are common emergency department visits which necessitate an orthopedic surgery evaluation for a traumatic elbow arthrotomy (TEA). A delay in this diagnosis can lead to septic arthritis, requiring more invasive surgical procedures, prolonged antibiotics, and possible long-term sequelae. To date, there is scarce literature on TEA. The purpose of this case report is to better educate the orthopedic community on a reliable method of detection for a TEA, including pediatric patients. Case report Case 1 - Twelve-year-old boy sustained a traumatic dog bite to the right elbow by a large stray dog. Evaluation in the emergency department revealed five 1 centimeter or smaller lacerations over the lateral elbow and another 1 cm laceration to the volar and proximal forearm. A saline load test (SLT) was performed from a posterior approach and was positive after 20cc of normal saline was injected into the joint. An arthroscopic irrigation and debridement were performed as definitive treatment. He was discharged with Augmentin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively revealed no signs of infection.Case 2 - Seven-year-old boy who was in a bicycle accident and sustained a large laceration over the posterior elbow. Evaluation in the emergency department revealed an approximately 15 by 4 cm laceration over the posterior elbow. A SLT was positive after 30cc's was injected from the anterolateral approach. He underwent arthroscopic irrigation and debridement as definitive treatment and was discharged home with Cephalexin BID for 7 days. Follow-up appointments at 1 and 4 weeks post-operatively showed no signs of infection. Conclusion Performing a SLT is a reliable method of detection to evaluate for a TEA. Our case report demonstrated confirmation of TEA in two pediatric patients based on positive SLT. We were able to treat these injuries appropriately with early surgical intervention and prophylactic antibiotics. Our early diagnosis and time-sensitive management prevented septic arthritis based on the patient's short-term follow-up examinations.

Background: Animal bite management are very crucial part in the post prophylaxis treatment. Objective: The purpose of the present study was to see the demographic profile of animal bite cases at a dedicated anti-rabies hospital. Methodology: This retrospective chart review based on secondary data received from animal bite register was conducted in the Department of Microbiology at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from January 2014 to December 2015 for a period of two years. All relevant data were noted from the registered record. Result: A total number of 17688 cases were collected from the register log book of animal bite. The mean age with standard deviation was 24.42±17.22 with the range of 1 to 99 years. The ratio between male and female was 2.33:1. The most common animal bite was dog bite which was 13574(76.7%) cases followed by cat, monkey, fox and weasel bite which were 3667(20.7%) cases, 163(0.9%) cases, 39(0.2%) cases and 22(0.1%) cases respectively. Lower extremity was the most site of bite by the animals which was 12936(73.1%) cases followed by upper extremity, waist, head & neck, face and trunk which were 3592(20.3%) cases, 428(2.4%) cases, 155(0.9%) cases, 116(0.7%) and 114(0.6%) cases respectively. The most common category of bite was category II which was 11800(66.7%) cases. Conclusion: In conclusion male young adult person bite by dog with category II are the most common victims of animal bites seeking for treatment. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 135-139

Introduction The Covid-19 pandemic triggered unprecedented nationwide regulations aimed primarily at slowing the spread of the virus. The objective of this study was to describe the effect of these regulations on the number and severity of trauma presentations to a regional emergency department in Kwa-Zulu Natal. Methods A retrospective cohort study of the triage register at Edendale Hospital Emergency Department was conducted, comparing all trauma presentations in the month of April 2020 with those from the preceding two years. The number of patients, mechanism of trauma and severity of illness were recorded and compared. Results A 47% reduction in the number of trauma cases was recorded for April 2020. The proportion of severe cases did not change. The categories showing a major decrease were motor vehicle accidents, pedestrian vehicle accidents, assault and gunshot wounds. The incidence of dog bite wounds and burns remained unchanged. Conclusion This study shows that the burden of trauma presenting to the emergency department was decreased in the month of April 2020 by the regulations implemented in response to the Covid-19 pandemic., Highlights • The study was conducted in a low-middle income setting in Africa. • The results may be compared with other African settings where similar measures are implemented. • The reduction of trauma and interpersonal violence is an important agenda in multiple African areas.

Rabies is one of strategic infectious animal diseases that attacks the central nervous system. Rabies is very widespread and is found in nearly 150 countries and regions on all continents, except Antarctica. Although West Nusa Tenggara is one of the nine provinces in Indonesia that is free of rabies, the number of dog bite victims reported on the island of Sumbawa with 32 samples of rabies-carrying animal brains identified as positive in early 2019 indicates the need to increase awareness of rabies transmission to Lombok Island. Increasing public knowledge which includes parents and students at primary school, elementary school and high school about rabies through surveys, counseling and demonstration is one of the efforts to prevent and control rabies. The results showed that the extension activities were able to increase participants' knowledge. High school students had the best level of knowledge (97.5% ± 2.08) when compared to the elementary school participants (93% ± 3.56) and elderly respondents (88.75% ± 4.79) of all indicators of knowledge about rabies. The combination of extension activities with hands-on practice has had a positive effect on increasing public knowledge about rabies

An 81-year-old man sustained a dog bite to his right lateral calf. Despite antibiotics, the patient continued to have leg swelling, severe itching, and a chronic wound. He was evaluated at the Wound Center, at which time a diagnosis of chronic venous insufficiency was made, and a venous reflux examination was recommended. The patient was scanned using Intersocietal Accreditation Commission Vascular Testing venous reflux protocol. Imaging was directed to the area of concern at the lateral calf. A 1.1-mm vein branch off the proximal calf great saphenous vein (GSV) was identified under the itching/trauma area with venous reflux identified. Venous reflux examination findings identified significant venous reflux from the right saphenofemoral junction through the distal calf GSV and vein branches. An elective right GSV endothermal venous ablation and stab phlebectomy were performed. The patient returned per protocol on postoperative day 2. He reported no pain and complete resolution of itching. Physical examination demonstrated marked improvement in the excoriated area. Surveillance duplex revealed no evidence of an endovenous heat-induced thrombosis. Venous stasis dermatitis occurs when there is inflammation of the skin caused by chronic venous insufficiency. In the early stages, symptoms include swelling at the ankles, hyperpigmentation, dryness, and itching. The development of stasis dermatitis can be precipitated by trauma, thereby unmasking underlying chronic venous insufficiency. Stasis dermatitis in this patient resolved because we treated the cause: chronic venous insufficiency.

Objective To report the successful treatment of septic nonunion in two dogs with large segmental defects secondary to long-bone fractures by using a novel human placenta-derived matrix (hPM) as adjunct to fixation. Animals One 3-kg 9-year-old neutered male Yorkshire terrier with a distal antebrachial fracture and one 6-kg 4-year-old spayed female miniature pinscher with a distal humeral fracture. Study design Short case series. Methods Both dogs presented for septic nonunion after internal fixation of Gustilo type II open diaphyseal fractures from dog bite injuries. During revision, debridement of nonviable bone resulted in segmental defects of 32% and 20% of the bone length for the antebrachial and humeral fractures, respectively. The antebrachial fracture was stabilized with a circular external fixator, and the humeral fracture was stabilized with biaxial bone plating. The fracture sites were not collapsed, and full length was maintained with the fixation. Autogenous cancellous bone graft and canine demineralized bone allograft were packed into the defects, and hPM was injected into the graft sites after closure. Results Radiographic union was documented at 8 weeks and 6 weeks for the antebrachial and humeral fractures, respectively. Both dogs became fully weight bearing on the affected limbs and returned to full activity. Conclusion Augmenting fixation with grafts and hPM led to a relatively rapid union in both dogs reported here.

Traumatic penile amputation and re-implantation or refashioning is scarcely reported in the literature. We present our case, the first report of successful glans refashioning in an 11-year-old boy, using the Bracka (refashioning) technique after complete glans penis amputation from a dog bite injury, with unsuccessful re-implantation due to the nature of the injury, during the dog bite. We elaborate on the process, technique, as well as the satisfactory postoperative results of the abovementioned procedure.

Arterial dissection is caused by intima damage and blood flow into the vascular wall, resulting in the separation of the intima and middle layer, intramural hematoma formation, and subsequently stenosis, occlusion, or aneurysm. A 68-year-old woman with bilateral common carotid artery dissection (CAD) caused by a dog bite two months prior was admitted to the hospital. Cerebral angiography, magnetic resonance angiography (MRA), and carotid color Doppler ultrasonography showed right CAD (aneurysm formation) with luminal stenosis (50%-69%), left common CAD (intramural hematoma formation). Bilateral common CAD caused by a dog bite is rare. The mechanism of CAD may be similar to iatrogenic dissection. After eliminating the contraindication of operation, right common carotid artery stenting was performed two months after conservative treatment.

As the literature has tended to focus on injuries and deaths due to active dog attacks, the following review was undertaken to examine the range of circumstances and mechanisms that may be associated with all types of fatal encounters with dogs. A search was undertaken of the literature and the Forensic Science SA, Australia, autopsy database for cases where deaths had been caused by dog-related activity. Only 2 cases were found in the autopsy database over a 15-year period from 2005 to 2019. The first was a 55-year-old man who bled to death from a large degloving dog bite to his forehead exacerbating underlying cardiovascular disease. The second was a 40-year-old previously splenectomized man who died of Capnocytophaga canimorsus sepsis shortly after being bitten by his dog. Dogs may be involved in vehicle crashes if drivers swerve to avoid them or if pedestrians attempt to rescue dogs that have strayed onto roads. In the literature, trauma has also occurred from "non-bite dog-related injuries" where individuals have been pulled over by, or tripped on, dogs. Dogs may also be responsible for specific types of infections such as echinococcosis and C. canimorsus, which may have potentially lethal consequences. Thus, the types of cases of injuries, illnesses, and deaths associated with dogs encountered by pathologists in a forensic context may be extremely diverse and not always straightforward.

This study was carried out to obtain a 16-year retrospective data on dog bites/suspected dog rabies cases and to determine the prevalence of rabies antigen in the brains of dogs slaughtered for human consumption in Makurdi, Benue State. Data for retrospective studies (2003 - 2018) of dog bite/suspected rabies cases was collected from both government and private veterinary clinics in Makurdi while dog brain samples were collected from the dog slaughter slab at the mammy market in Makurdi. A total of 139 dog bite/suspected rabies cases were reported between January, 2003 and December, 2018 in the veterinary clinics with majority (55.3%) of the victims being children less than 16-years old. Only 18 (12.2%) of the offending dogs were quarantined at the time of bite, 11 of which died in quarantine. Five samples from the dogs that died in quarantine were later confirmed positive for rabies at the National Veterinary Research Institute Vom, Nigeria. Of the 464 brain samples collected from the slaughter slab, 52 (11.2%) tested positive for rabies antigen through the direct fluorescent antibody technique. The presence of rabies antigen in apparently healthy dogs may serve as a source of spread of the virus to the public as most people do not regard bites from healthy dogs as possible exposures. There is need for public health awareness on the health challenges posed by dog bites especially on the possibility of developing rabies from such bites, and the need to promptly report every bite so that proper medical attention can be given. With the world looking at eliminating canine mediated rabies by the year 2030, mass enlightenment programmes regarding rabies and its prevention in Makurdi is strongly recommended to help achieve this goal. Keywords: Bites, Dogs, Rabies, Makurdi, Nigeria, Retrospective

In most cases of dog bites, there are low-risk injuries. However, more serious injuries may occur in rare cases which may include cerebral involvement due to skull fracture. The present case report aims to describe the medical care, clinical evolution, and impacts of lesions of a case of dog bite in a University Hospital. A 2-month-old female infant was in the baby-safe sleeper under supervision of the caregiver when she was attacked by a family dog. The infant showed uncontrollable vomiting, decreased level of consciousness, hypoactivity, fixed and pinpoint pupils, and hypovolemic shock. Owing to the severity of the fracture with scalping of the right temporal bone with exposed fracture and active bleeding, high-resolution computed tomography of the cranial region was indicated. The infant was referred to the surgical center to perform exploratory craniotomy. Plastic surgery was performed to allow debridement of devitalized tissues, revision of hemostasis and suture of scalp in a single continuous plane, and cartilage in the right ear. Owing to the severity of the lesions, the wounds evolved with mouth corner deviation to the left, and the infant had eyelid myoclonia and clonic seizures in the right upper limb. The patient remained in the ICU for 12 days with seizures controlled by anticonvulsants and received antibiotic therapy. The infant attended the outpatient clinic for follow-up treatment in these areas: pediatric neurology, neurosurgery, plastic surgery, and motor physical therapy and visual rehabilitation. Nevertheless, the infant showed sequelae including left hemiparesis, hypertonia, hyperreflexia, and structural epilepsy. In pediatrics, the evaluation of dog bite victims requires systematization of medical care and quick hemodynamic and ventilatory support to reduce and prevent more severe sequelae, such as the neurological impairment of the present case. In addition, public health policies should emphasize the risks associated with dog bite incidents, even in domestic environments and by familiar animals.

Background: Child health promotion is a crucial challenge in the current decade especially in developing countries like Egypt, and this study is considered as one step from thousands of steps needed to achieve this aim. Objective: To measure the prevalence of injuries, determine the patterns of injuries, and assess the associated risk factors of injuries among primary school children in Port-Said City. Methods: In this descriptive, cross-sectional study, a non- proportionate stratified random sampling was used in this project . We collected data on 25th of March 2019 from 2128 primary school pupils from 11 schools . The pupils’ age ranged from 7 to 13 years in all six grades in port-Said, Egypt. SPSS statistics was used to analyze and interpret the data collected . Results: After doing analysis, it was found out that only 708 pupils (33.27%) didn’t suffer from injury before, while 1420 pupils (66.73%) suffered from injury with boys (54.51%) having a higher rate than girls (45.49 %). The most common injury for both males and females is falling while the least percentage was dog bite . Most injuries occurred at home (38.88%) surprisingly, while injuries in schools come in the 3rd place by 14.15% . Conclusion : Egypt and the other countries have to pay attention to achieve the aim of child health promotion.

Background Dog bites are a common cause of pediatric trauma requiring hospital admission. We aim to describe pediatric bite victims, associated injuries and interventions. Methods Children (≤ 18 years old) were identified with an ICD-9 diagnosis of dog bite in the Kids' Inpatient Database for the years 2006, 2009 and 2012. National estimates were obtained using case weighting. Multivariable logistic regression was performed. Results We identified 6323 admissions for a dog bite with mean age of 6.63 years. Patients were predominately male (56.9%), non-Hispanic white (61.9%), resided in the South (35.1%), and in an urban environment (59.9%). Almost one third underwent a surgical procedure. Open wounds of the head, neck and trunk were the most common injury and decreased in prevalence with increasing age. Open wounds of the extremities were the second most common and the prevalence increased with increasing age. Children aged 1–4 and 5–10 years were both more than three times more likely to be admitted than those more than age 11. Conclusions Dog bite injuries are common for pediatric patients. Children less than age 11 are at greatest risk, particularly in the summer. Dog safety training should be focused on elementary and middle school children close to the start of summer vacation. Level of evidence III.

Introduction: Canalicular injury is commonly encountered in lid trauma. A multitude of techniques and stents are available to manage canalicular lacerations. Monocanalicular stents offer a simple, technically easy and cost-effective solution for managing such cases. Objective: This is a retrospective review of the patients presenting with canalicular lacerations to a tertiary eye hospital from January 2014 to September 2017. We evaluated factors like time of surgery, cause of injury, time of stent removal and their association with the surgical outcome. Additionally, we also reviewed the current data available in literature on the exclusive use of monocanalicular stents for the management of all types of canalicular injuries. Methods: Retrospective patient file review. Results: We evaluated 30 cases of canalicular injuries in 30 patients. The majority of our patients were males (24, 80%), and the mean age was 32.11±15.09 (4-59) years. The mode of injury was road traffic accidents (RTA) in 20 (66.7%), assault with sharp edged weapons in 8 (26.7%) and dog bite in 2 (6.6%) cases. The mean time of repair was 17.2±9.37 (6-36) hours after injury and the mean time of stent removal/ extrusion was 3.5±0.99 (0.5-5) months. The cases were divided based on time of repair i.e., within 24 hours (21 cases) or after 24 hours (9 cases) from the onset of injury. The extrusion rates were 14.3% (3) and 44.4% (4) respectively in the two groups. Our overall anatomical success rate was 86.7% and functional success rate of 76.7%. Conclusions: Overall failure rate was 23.3% (7 out of 30). Delay in surgery (>24 hours) and dog bites were associated with a poorer prognosis of canalicular repair using monocanalicular stents. Abbreviations: FDDT = Fluorescein dye disappearance test, SPSS = Statistical Package for Social Sciences, RTA = Road Traffic Accident.