Master of Medicine in General Surgery (Dissertations)

Short term poor outcome determinants of patients with traumatic pelvic fractures: Across-sectional study at three private not for profit hospitals of Nsambya, Lubaga and Mengo.

Wed, 01 Aug 2018 00:00:00 GMT

Short term poor outcome determinants of patients with traumatic pelvic fractures: Across-sectional study at three private not for profit hospitals of Nsambya, Lubaga and Mengo. Osuta, Hope Methuselah Background: Although relatively rare, pelvic fractures signify major trauma that are frequently associated with multiple injuries, threat to life and poor functional outcome. This study aimed to establish poor outcome determinants in traumatic pelvic fracture patients admitted and treated at three urban PNFP Hospitals in Kampala. Methods: A cross-sectional study reviewing charts of patients admitted and treated at three urban PNFP hospitals in Kampala, Uganda between January 2014 and December 2018. A pretested data abstraction form was used to obtain data. All variables with a p-value < 0.24 at bivariate logistic regression were included in multivariate analysis. A backward stepwise elimination method was used to identify predictors of poor outcome, with Odds Ratios at 95% confidence intervals used to report results. Data was analyzed using STATA version 14.0 at a p value < 0.05. Results: Of the 73 patients admitted and treated for pelvic fractures, 40(54%) were males and the mean age of 37.4± 17.7 years. Overall, 83.3% fractures were stable while 16.7% were unstable. The most commonly associated injuries were in extremities (52.38%), head and neck region (25.40%), abdomen (7.94%) and chest regions (7.94%). Factors significantly associated with poor outcome among patients with pelvic fractures were surgical intervention (p = 0.001) and poor heart rate (p = 0.008), regardless of whether stable or unstable pelvic fractures. Conclusion: Poor Outcome determinants for pelvic fracture were operational interventions and elevated heart rate. Associated injuries were mainly in the extremities and head and neck regions. Deliberate and focused attention should be given to stabilize the cardiovascular system in pelvic fracture patients who present with elevated heart rate. Very close monitoring of pelvic fracture patients who require or have undergone operative intervention is very essential for optimal outcome. Mutyaba Frederick; Sr.Nassali Gorretti

Bed rest versus early mobilization in preventing post-dural puncture headache in spinal anaesthesia a randomized controlled study

Thu, 01 Jan 2015 00:00:00 GMT

Bed rest versus early mobilization in preventing post-dural puncture headache in spinal anaesthesia a randomized controlled study Mwesigye, Ismael Samytec Background: Postdural Puncture Headache (PDPH) is a rare occurrence in spinal anaesthesia. Many studies have been done about the possible causes and CSF leakage has been identified as the cause of this headache. Bed rest has been used to control this headache once it occurs but not known whether it could also prevent it. Early mobilization in this study was defined as any posture a patient can resume other than keeping in supine position. . Objectives: To establish whether early mobilization increases chances of developing PDPH in Nsambya hospital. Methodology: This was an open randomized controlled trial. A total of 110 patients were enrolled and randomized in each study arm. Questionnaires were used, and informed consent obtained. Spinal anesthesia was given using a 25 gauge needle. Participants were assessed for PDPH at 6, 12, 24, 48hours and a follow up at one week. Data was analyzed using SPSS study variables were HIV status, BMI, age, gender, number of needle attempts and type of operation Significance level was set at P<0.05). Results: Seventy eight (79.1%) females, the majority of participants were overweight 98(89%). Emergency operations were 62(56.4%) while elective operations (48)43.6%. Laparotomy 14(11.8%), caesarian sections were 72(65.5%), perineum and groin operations were 14(12.7%), trauma and orthopedic were 9(8.2%) and other operations were 2(1.8%). HIV sero positive participants were 15(13.6%) seronegative participants were 93 (84.5%). 12 patients developed PDPH 4(3.6%) from the early mobilization group and 8(7.2%) from the bed rest group though there was no statistical significance P = 0.136 Conclusion: There are no benefits in keeping post spinal patients on bed rest though if PDPH develops lying flat reduces this headache. All those participants who developed the headache were able to improve on paracetamol without other aggressive management like epidural blood patch Lawrence Ekwaro & Ephrem Gum; Lawrence Ekwaro & Ephrem Gum

Uganda Martyrs University Mother Kevin Postgraduate Medical School Nsambya Dyspepsia at St Francis Hospital, Nsambya

Mon, 01 Feb 2021 00:00:00 GMT

Uganda Martyrs University Mother Kevin Postgraduate Medical School Nsambya Dyspepsia at St Francis Hospital, Nsambya Akurete, Daisy Background: Dyspepsia is one of the commonest occurring gastrointestinal disorders in our region with a Global prevalence of between 7-45% and a regional prevalence of 65%. Most studies on dyspepsia have differences in findings and proposed standard of care. The current practices in our setting are centered on investigations and initial treatment with PPIs and antibiotics before referral for endoscopy and biopsy. This study is to describe the commonest presenting complaints, endoscopy and histopathology findings in patients with dyspepsia in our setting. Objectives: To describe the endoscopy findings and histopathology findings in patients with dyspepsia. Methods: A descriptive cross-sectional study in which 115 dyspeptic patients who presented to St Francis hospital, Nsambya underwent endoscopy and biopsy. Consecutive sampling was used and data was entered in a preformed questionnaire. Ethical approval for the study was got from the Hospital and University Research and Ethics committees and written consent was got for all the participants in this study. Data collected was entered into Microsoft Excel and analyzed with STATA version 14.0 Results: Dyspepsia prevalence was more among the male at 53.9% than the female at 46.1%. The mean age of participation in this study was 53years. The commonest presenting complaint was epigastric pain which was noted in 63.6% of the participants followed by hematemesis in 14.3% and vomiting feeds in 6.4%. Most of the patients at presentation had only one clinical symptom (80.9%) while those with more than one presenting symptom were (19.1%). There was no relationship between the age and sex and the presenting complaints among patients with p= 0.290 and p= 0.680 respectively. The commonest findings at endoscopy were gastritis- 73 participants, followed by PUD- 23, Duodenitis- 22, GERD-17, Oesophagitis—15, Tumor-11, Hernia-9, Polyps- 4. No normal findings were noted at endoscopy. At histology, there was no reported normal mucosa, the most common finding was gastritis in 62.6% of the patients. 10.4% participants had gastric malignancy and 1.7% had intestinal metaplasia. Histopathology findings across age and sex were not significantly different. However, in 3 patients, diagnosed with Peptic ulcer disease at endoscopy, 2 had intestinal metaplasia and one had gastrointestinal stromal tumor at histology. The concordance rate between endoscopy and histology was 76.9% Conclusion: From our study, the commonest finding described at Endoscopy was Gastritis at 42% while at histopathology, the commonest finding was it would be beneficial for patients with dyspepsia who undergo endoscopy to have biopsies taken off for histopathology Sr Nassali Gorretti; Basimbe Francis; Othieno Emmanuel