Corneal higher order aberrations by Sirius topography and their relation to different refractive errors.

PURPOSE: To compare the root mean square (RMS) of anterior corneal higher-order aberrations (HOAs) in ametropic and emmetropic eyes. METHODS: This retrospective observational study was conducted at the Department of Ophthalmology, Tishreen University Hospital, Latakia, Syria. Study eyes were divided into four groups based on refractive error: mild-to-moderate myopia, hypermetropia, myopic astigmatism, and emmetropic eyes as controls. The following anterior corneal HOAs were evaluated using the Scheimpflug-Placido Sirius (CSO, Italy) tomographer over 6 mm pupil: Root mean square (RMS) total corneal HOAs, RMS trefoil, RMS coma and RMS spherical aberrations. RESULTS: RMS values of total HOAs, trefoil and coma showed statistically significant differences in all four groups (P < 0.05, all). HOAs were noted to be lowest in the control group (0.18 ± 0.09, 011 ± 0.08 and 0.09 ± 0.08 µm, respectively) and highest in the myopic astigmatism group (0.31 ± 0.16, 0.15 ± 0.12, 0.17 ± 0.14 µm, respectively). RMS spherical aberration was lowest in the astigmatism group (0.00 ± 0.16 µm) with a statistically significant difference from that in the control group (0.05 ± 0.07 µm, P = 0.049). CONCLUSION: The mean RMS values of total HOAs, trefoil and coma were highest in the astigmatism group and lowest in the control group. However, spherical aberration was minimal in the astigmatism group. A better understanding and targeted treatment of higher-order aberrations in ametropic human eyes, and in particular eyes with astigmatism, may enhance visual quality and performance in the treatment of refractive errors. Recognising atypical HOAs may also assist in the early detection of pathological conditions such as keratoconus.

Smart Wearables for the Detection of Cardiovascular Diseases: A Systematic Literature Review.

Background: The advancement of information and communication technologies and the growing power of artificial intelligence are successfully transforming a number of concepts that are important to our daily lives. Many sectors, including education, healthcare, industry, and others, are benefiting greatly from the use of such resources. The healthcare sector, for example, was an early adopter of smart wearables, which primarily serve as diagnostic tools. In this context, smart wearables have demonstrated their effectiveness in detecting and predicting cardiovascular diseases (CVDs), the leading cause of death worldwide. Objective: In this study, a systematic literature review of smart wearable applications for cardiovascular disease detection and prediction is presented. After conducting the required search, the documents that met the criteria were analyzed to extract key criteria such as the publication year, vital signs recorded, diseases studied, hardware used, smart models used, datasets used, and performance metrics. Methods: This study followed the PRISMA guidelines by searching IEEE, PubMed, and Scopus for publications published between 2010 and 2022. Once records were located, they were reviewed to determine which ones should be included in the analysis. Finally, the analysis was completed, and the relevant data were included in the review along with the relevant articles. Results: As a result of the comprehensive search procedures, 87 papers were deemed relevant for further review. In addition, the results are discussed to evaluate the development and use of smart wearable devices for cardiovascular disease management, and the results demonstrate the high efficiency of such wearable devices. Conclusions: The results clearly show that interest in this topic has increased. Although the results show that smart wearables are quite accurate in detecting, predicting, and even treating cardiovascular disease, further research is needed to improve their use.

Reviewing Federated Machine Learning and Its Use in Diseases Prediction.

Machine learning (ML) has succeeded in improving our daily routines by enabling automation and improved decision making in a variety of industries such as healthcare, finance, and transportation, resulting in increased efficiency and production. However, the development and widespread use of this technology has been significantly hampered by concerns about data privacy, confidentiality, and sensitivity, particularly in healthcare and finance. The "data hunger" of ML describes how additional data can increase performance and accuracy, which is why this question arises. Federated learning (FL) has emerged as a technology that helps solve the privacy problem by eliminating the need to send data to a primary server and collect it where it is processed and the model is trained. To maintain privacy and improve model performance, FL shares parameters rather than data during training, in contrast to the typical ML practice of sending user data during model development. Although FL is still in its infancy, there are already applications in various industries such as healthcare, finance, transportation, and others. In addition, 32% of companies have implemented or plan to implement federated learning in the next 12-24 months, according to the latest figures from KPMG, which forecasts an increase in investment in this area from USD 107 million in 2020 to USD 538 million in 2025. In this context, this article reviews federated learning, describes it technically, differentiates it from other technologies, and discusses current FL aggregation algorithms. It also discusses the use of FL in the diagnosis of cardiovascular disease, diabetes, and cancer. Finally, the problems hindering progress in this area and future strategies to overcome these limitations are discussed in detail.

Corneal higher-order aberration changes after accelerated cross-linking for keratoconus.

AIM: To evaluate changes in corneal higher-order aberrations (HOAs) following epithelium-off accelerated corneal cross-linking (A-CXL) and to explore the impact on visual acuity. METHODS: In this retrospective case series, 32 eyes of 24 patients with keratoconus (KC) underwent A-CXL. Treatment was delivered at 10 mW/cm2 for 9 min with a total dose of 5.4 J/cm2. The following anterior corneal HOAs: total corneal HOAs, trefoil, secondary trefoil, coma, secondary coma, secondary astigmatism and spherical aberrations were analysed using the Scheimpflug-Placido Sirius (CSO, Italy) corneal topographer at baseline and 12 months following treatment. Multivariate analysis was used to evaluate the independent effect of HOA subtypes on changes in uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). RESULTS: At one year post CXL, UDVA and CDVA were significantly improved, -0.13 ± 0.19 LogMAR (P = 0.0005) and -0.08 ± .0.11 LogMAR (P = 0.0003), respectively. The mean preoperative trefoil, secondary trefoil, secondary coma and secondary astigmatism were 0.95 ± 0.46; µm, 0.20 ± 0.11; µm, 0.29 ± 0.19; µm and 0.42 ± 0.17 µm, respectively. At one year, the mean values decreased significantly to 0.77 ± 0.47 µm, 0.15 ± 0.11 µm, 0.25 ± 0.18 µm and 0.34 ± 0.18 µm, respectively (P < 0.05, for all). No independent relationship between any HOA changes and change in UDVA was observed. A reduction in secondary coma aberration was associated with a change in CDVA (95% CI 0.01-1.34, P = 0.048; ß = 0.67). CONCLUSION: A 9-min protocol of Accelerated corneal cross-linking is an effective treatment in improving corneal HOAs at 12 months follow up, in eyes with progressive keratoconus at one year follow-up. A change in secondary coma had a statistically significant and independent effect on CDVA.

Machine Learning and Smart Devices for Diabetes Management: Systematic Review.

(1) Background: The use of smart devices to better manage diabetes has increased significantly in recent years. These technologies have been introduced in order to make life easier for patients with diabetes by allowing better control of the stability of blood sugar levels and anticipating the occurrence of dangerous events (hypo/hyperglycemia), etc. That being said, the main objectives of the self-management of diabetes is to improve the lifestyle and life quality of patients with diabetes; (2) Methods: We performed a systematic review based on articles that focus on the use of smart devices for the monitoring and better management of diabetes. The search was focused on keywords related to the topic, such as "Diabetes", "Technology", "Self-management", "Artificial Intelligence", etc. This was performed using databases, such as Scopus, Google Scholar, and PubMed; (3) Results: A total of 89 studies, published between 2011 and 2021, were included. The majority of the selected research aims to solve a diabetes management problem (e.g., blood glucose prediction, early detection of risk events, and the automatic adjustment of insulin doses, etc.). In these studies, wearable devices were used in combination with artificial intelligence (AI) techniques; (4) Conclusions: Wearable devices have attracted a great deal of scientific interest in the field of healthcare for people with chronic conditions, such as diabetes. They are capable of assisting in the management of diabetes, as well as preventing complications associated with this condition. Furthermore, the usage of these devices has improved illness management and quality of life.

Smart Wearables for the Detection of Occupational Physical Fatigue: A Literature Review.

Today's world is changing dramatically due to the influence of various factors. Whether due to the rapid development of technological tools, advances in telecommunication methods, global economic and social events, or other reasons, almost everything is changing. As a result, the concepts of a "job" or work have changed as well, with new work shifts being introduced and the office no longer being the only place where work is done. In addition, our non-stop active society has increased the stress and pressure at work, causing fatigue to spread worldwide and becoming a global problem. Moreover, it is medically proven that persistent fatigue is a cause of serious diseases and health problems. Therefore, monitoring and detecting fatigue in the workplace is essential to improve worker safety in the long term. In this paper, we provide an overview of the use of smart wearable devices to monitor and detect occupational physical fatigue. In addition, we present and discuss the challenges that hinder this field and highlight what can be done to advance the use of smart wearables in workplace fatigue detection.

Rotigotine patch prescription in inpatients with Parkinson's disease: evaluating prescription accuracy, delirium and end-of-life use.

BACKGROUND: Rotigotine patch, a trans-dermal dopamine agonist, is used acutely to replace oral dopaminergic medications for inpatients with Parkinson's disease where enteral routes are no longer available, and is also an option in end-of-life care where patients can no longer swallow. Concerns regarding acute use of Rotigotine include difficulty achieving dopaminergic equivalence, promotion of delirium/hallucinations and promotion of terminal agitation. OBJECTIVE: our objectives were to establish: (i) accuracy of Rotigotine prescribing, (ii) rates of delirium/hallucinations and (iii) rates of terminal agitation. METHOD: we retrospectively evaluated the use of Rotigotine in an inpatient population at a UK teaching hospital. Prescriptions between January 2018 and July 2019 were identified and inpatient records were analysed. OPTIMAL Calculator 2 was used as a gold standard for assessing conversion of oral dopaminergic medication to Rotigotine. RESULTS: a total of 84 inpatients were included. 25 (30%) patients were prescribed the recommended dose of Rotigotine; 31 (37%) higher and 28 (33%) lower than recommended. A total of 15 of 41 (37%) patients with dementia and 22 of 49 (45%) patients with delirium before initiation of Rotigotine inappropriately received the higher dose; 20 (24%) patients developed new/worsening delirium and 8 (10%) patients developed new/worsening hallucinations; and 59 (70%) patients were dead at time of evaluation, of these 40 (68%) died in hospital, 10 (25%) of whom experienced terminal agitation. CONCLUSIONS: acute conversion of oral dopaminergic medication to trans-dermal Rotigotine patch remains problematic despite the availability of validated tools. Inappropriate dosing may precipitate or worsen delirium/hallucinations. Use at end-of-life requires further evaluation.

Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage.

BACKGROUND: A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems. METHODS: These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status. RESULTS: The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1-80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department. CONCLUSION: Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.

Reporting guidelines for artificial intelligence in healthcare research.

Reporting guidelines are structured tools developed using explicit methodology that specify the minimum information required by researchers when reporting a study. The use of artificial intelligence (AI) reporting guidelines that address potential sources of bias specific to studies involving AI interventions has the potential to improve the quality of AI studies, through improvements in their design and delivery, and the completeness and transparency of their reporting. With a number of guidance documents relating to AI studies emerging from different specialist societies, this Review article provides researchers with some key principles for selecting the most appropriate reporting guidelines for a study involving an AI intervention. As the main determinants of a high-quality study are contained within the methodology of the study design rather than the intervention, researchers are recommended to use reporting guidelines that are specific to the study design, and then supplement them with AI-specific guidance contained within available AI reporting guidelines.

HEAD Metamodel: Hierarchical, Extensible, Advanced, and Dynamic Access Control Metamodel for Dynamic and Heterogeneous Structures.

The substantial advancements in information technologies have brought unprecedented concepts and challenges to provide solutions and integrate advanced and self-ruling systems in critical and heterogeneous structures. The new generation of networking environments (e.g., the Internet of Things (IoT), cloud computing, etc.) are dynamic and ever-evolving environments. They are composed of various private and public networks, where all resources are distributed and accessed from everywhere. Protecting resources by controlling access to them is a complicated task, especially with the presence of cybercriminals and cyberattacks. What makes this reality also challenging is the diversity and the heterogeneity of access control (AC) models, which are implemented and integrated with a countless number of information systems. The evolution of ubiquitous computing, especially the concept of Industry 4.0 and IoT applications, imposes the need to enhance AC methods since the traditional methods are not able to answer the increasing demand for privacy and security standards. To address this issue, we propose a Hierarchical, Extensible, Advanced, and Dynamic (HEAD) AC metamodel for dynamic and heterogeneous structures that is able to encompass the heterogeneity of the existing AC models. Various AC models can be derived, and different static and dynamic AC policies can be generated using its components. We use Eclipse (xtext) to define the grammar of our AC metamodel. We illustrate our approach with several successful instantiations for various models and hybrid models. Additionally, we provide some examples to show how some of the derived models can be implemented to generate AC policies.

Development and Validation of a Railway Safety System for Nordic Trains in Isolated Territories of Northern Quebec Based on IEEE 802.15.4 Protocol.

Connected objects are deployed all over the world. Thus, they are contributing to improving communications. In urban areas, technological challenges are gradually being overcome, and advances in this area are exponential. Unfortunately, isolated territories such as northern Quebec do not beneficiate from this technological progress. Yet, northern Quebec relies on abundant natural resources, with notably its huge hydroelectric dams and iron mines, and therefore, the region's economic life revolves essentially around the exploitation of these resources and is heavily reliant on rail transportation. However, according to Transport Canada, 1246 railroad accidents were reported in 2019 to the Transportation Safety Board (TSB). Thirty-eight people described as trespassers lost their lives, and five railroad employees were fatally injured. In this context, we present the implementation of a security system in an isolated environment for employees intervening on the railroad track to warn them of the imminent arrival of a train. Due to the context of the isolated environment, i.e., without an electrical network, without internet, and without an LTE network, a solution for employees has been developed using a Zigbee telecommunication system and a connected watch. A case study on a train operating in a remote and isolated area in northern Quebec is presented to validate the performance of the proposed system based on an open-source and customizable solution.

State of the Art of Telecommunication Systems in Isolated and Constrained Areas.

Smart objects are deployed globally, contributing to improved communications and the growth of industrial systems' performances. Unfortunately, isolated territories are generally excluded from this progress. Remote areas in Canada are no exception. Thus, about two hundred thousand people are living in isolated regions in Canadian territory. The development of these communities is slowed down not only by an outdated energy supply, but they are also dependent on telecommunication systems not fully deployed in those regions, thus contributing to the amplification of those populations' isolation. Furthermore, the magnetic field in some regions of the planet and very often in isolated areas undergoes partial or total absorption, known as white areas, making the propagation of the signal very delicate. As a part of this article, a state of the art of telecommunication solutions available in an isolated environment is applied with a critical analysis based on several criteria. It shows the ability to use an original approach based on a captive balloon. Despite the proposed solution's feasibility, several challenges need to be addressed before formally adopting it. These challenges include: (i) controlling the height of the balloon; (ii) stabilization of the balloon; and (iii) powering the system. The list of references given at the end of the paper should offer aids for the industry and for researchers working in this field.

Characteristics of pediatric maxillofacial fractures in Kuwait: A single-center retrospective study.

BACKGROUND: Pediatric maxillofacial fractures always present a challenge due to the unique nature of the facial skeleton anatomy and development. The aim of this study was to investigate the incidence, etiology, site of fracture, and management modalities of pediatric maxillofacial fractures in Kuwait. METHODS: A retrospective cross-sectional study was conducted. The records of all pediatric patients who were diagnosed with maxillofacial fractures and admitted to one of the major hospitals in Kuwait between January 2007 and March 2020 were reviewed. RESULTS: A total of 186 patients aged between 0 and 13 years old were included. An average of 13 patients was seen each year between 2007 and 2020. The leading cause of the pediatric maxillofacial trauma was road traffic accidents (RTA) that accounted for 38.2% of the patients followed by 22% falls from height (FFH). Male patients were more affected than females, with a ratio of 2.3:1. More than half of the children had mid-face fractures, of which 57% were in multiple sites. Conservative management was the main approach for 52.2% of the patients. CONCLUSIONS: Pediatric maxillofacial fractures were mainly attributed to road traffic accidents in Kuwait. Mid-face bone fractures were reported more than mandibular fractures and were mostly managed conservatively.

High success rates for the use of sofosbuvir/ombitasvir/paritaprevir/ritonavir + ribavirin and sofosbuvir/simeprevir/daclatasvir + ribavirin in retreatment of chronic hepatitis C infection after unsuccessful sofosbuvir/daclatasvir therapy: a real-life experience.

The aim of this work was assessment of the efficacy and tolerability of two different regimens for retreatment of hepatitis C virus (HCV) patients who failed to respond to SOF/DCV-based therapy. This prospective study included 104 HCV patients who failed to respond to SOF/DCV-based therapy. Patients were randomly allocated to two groups. Efficacy and tolerability were assessed. The 12-week sustained virological response (SVR12) rates were 96% and 94.4% in groups B and A, respectively, with no significant difference (p = 1.000). Most adverse events reported were mild to moderate, with no deaths during the study. Multi-target direct-acting antiviral (DAA) combinations are efficient for retreatment of HCV patients after failure of SOF/DCV-based therapy in real-world management.ClinicalTrials.gov identifier: NCT02992457.

Activity Budget and Feeding Ecology of Geladas (Theropithecus gelada obscurus) around Abogedam Church West of Debre Berhan Town, Ethiopia.

Geladas are the most distinctive of Ethiopian endemic mammals, representing the last extant species of primate genus that have a very restricted distribution in the northern Ethiopian plateau. The activity budget and feeding ecology of geladas (Theropithecus gelada obscurus) were studied around Abogedam Church, Ethiopia, from May to October 2014, encompassing dry and wet seasons. The scan sampling method was applied to collect behavioural data on the identified band. Activity scans were collected at 15-minute intervals for up to five minutes duration from 0700 to 1730 h. The activity recorded for each individual was the first activity that lasts for five seconds. During each scan, individuals were recorded as performing activities: feeding, moving, resting, playing, aggression, grooming, sexual activity, and others. On average, geladas devoted 57.19% feeding, 14.82% resting, 14.92% moving, 4.83% playing, 2.53% aggression, 4.14% grooming, 1.23% sexual activity, and 0.34% other activities such as vocalization, defecation, and urination. Forty-one plant species were consumed by geladas that belonged to 18 families of which 53.66% were grasses. This study provides basic information on further studies and motivates conservationists to plan the management of unprotected areas at the vicinity of agricultural lands where such endemic animals dwell.

Vitamin E supplementation ameliorates the hepatotoxicity induced by Tramadol: toxicological, histological and immunohistochemical study.

Several deleterious effects of Tramadol including deaths were reported especially when used in large doses. Being metabolized mainly in the liver, Tramadol have serious hepatotoxic effects. This study investigates the effect of vitamin E on Tramadol-induced hepatotoxicity in rats by evaluating the antioxidant biochemical markers, the histopathological and immunohistochemical changes.Thirty adult mature male albino rats were divided into five groups (Gs); G1: negative control; G2: received Tramadol 150 mg/kg, G 3-5: received Tramadol plus vitamin E in concentrations of 50 mg/kg, 100 mg/kg and 200 mg/kg respectively. Liver function parameters and oxidative markers in liver tissue (CAT, SOD, GSH, and MDA) were estimated. Liver samples were processed for histopathological and immunohistochemical (Caspase 3 and TNF[Formula: see text]) examinations. The results indicated that Sub-chronic administration of Tramadol resulted in impaired liver functions, increased oxidative stress parameters with decreased antioxidant capacity of liver tissues, severe hepatocellular damage (hydropic degeneration, steatosis and apoptosis) and strong immunoexpression to TNF[Formula: see text] and Caspase 3. All these effects were ameliorated with concomitant administration of vitamin E especially with high doses. The co-treatment of Tramadol-intoxicated rats with Vitamin E, especially in high doses, protects against hepatic toxicity.

Study of smart grid cyber-security, examining architectures, communication networks, cyber-attacks, countermeasure techniques, and challenges.

Smart Grid (SG) technology utilizes advanced network communication and monitoring technologies to manage and regulate electricity generation and transport. However, this increased reliance on technology and connectivity also introduces new vulnerabilities, making SG communication networks susceptible to large-scale attacks. While previous surveys have mainly provided high-level overviews of SG architecture, our analysis goes further by presenting a comprehensive architectural diagram encompassing key SG components and communication links. This holistic view enhances understanding of potential cyber threats and enables systematic cyber risk assessment for SGs. Additionally, we propose a taxonomy of various cyberattack types based on their targets and methods, offering detailed insights into vulnerabilities. Unlike other reviews focused narrowly on protection and detection, our proposed categorization covers all five functions of the National Institute of Standards and Technology cybersecurity framework. This delivers a broad perspective to help organizations implement balanced and robust security. Consequently, we have identified critical research gaps, especially regarding response and recovery mechanisms. This underscores the need for further investigation to bolster SG cybersecurity. These research needs, among others, are highlighted as open issues in our concluding section.

Genito-urinary Reconstruction in Female Children With Congenital Adrenal Hyperplasia: Favorable Surgical Outcomes can be Achieved by Contemporary Techniques and a Dedicated Multidisciplinary Management.

INTRODUCTION: Congenital adrenal hyperplasia (CAH) is the most common cause of genital atypia in females. A dedicated multidisciplinary team (MDT) should be included for an optimal management. Here, we aimed to review our surgical experience and to assess long-term urinary, gynecological and endocrine outcomes after primary genitoplasty in this specific cohort. METHODS: Patients born with CAH and who underwent feminizing genitoplasty in our institution were retrospectively identified (2001-2021). We analyzed patients' characteristics, intraoperative details, and postoperative urinary, gynecological, and endocrine outcomes. RESULTS: Forty patients were included and followed-up for a median (IQR) time of 7 (1-19) years. Thirty-eight (95%) had 21-hydroxylase deficiency. After multidisciplinary decision and written consent from patient and/or family, a single-stage reconstructive surgery was performed at a median age of 10 (3-165) months. Median length of hospital stay was 5 (1-7) days. Procedures were: PUM (N = 35 (87.5%)), TUM (N = 3 (7.5%)), urogenital mobilization was unnecessary in 2 (5%). Reduction clitoroplasty was done in 33 (82.5%) patients. Only 3 (7.5%) experienced significant Clavien-Dindo complications requiring additional surgery during the follow-up period. Recurrent urinary tract infections (UTI) occurred in 6 (15%), one required ureteric reimplantation for symptomatic high-grade vesicoureteric reflux. All patients over 3 years were toilet-trained without incontinence. Severe vaginal stenosis occurred in 1 (2.5%) patient. In patients who achieved puberty, 6/9 had vaginal calibration at a median age of 17.3 (16-21) years without detected stenosis. One (2.5%) had major hypertrophy of the right labia minora requiring labiaplasty. Nine (22.5%) reached puberty. Two (5%) patients developed acne/hirsutism. Short stature was noted in 11 (27.5%) and obesity in 18 (45%). CONCLUSION: Based on our contemporary series, genitourinary reconstructive surgery for female patients born with CAH is technically feasible and safe with a low complication rate. A regular follow-up with a MDT to assess long-term complications is necessary, and it is vital to inform patients and families about the different management options with all the risks and benefits of surgery. TYPE OF THE STUDY: original research, clinical research. LEVEL OF EVIDENCE: Level 3 retrospective study.

Epidemiology of adult hand injuries presenting to a tertiary hand surgery unit: a review of 4216 cases.

This study investigates the pattern of hand injuries presenting to a UK regional tertiary centre. All referrals to our Hand Surgery Unit in 2019 were reviewed. Subgroup analyses of sex, deprivation, occupational injuries and assault cases were carried out. Over the study period, 4216 cases were referred. Most were male (70%), with a median age of 36 years and from a deprived area (75.2%). Soft tissue injury was documented in 53.6% and bone injury (fracture/dislocation) in 52.4%. Surgical management was required in 2214 (52.5%) cases. Work-related injuries accounted for 16.7% of cases and were more likely to require surgery. Assault-related injuries accounted for 8% of cases, with a male preponderance. Our findings can help facilitate service provision and guide regional and national prevention policies.Level of evidence: III.