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Ganga hospital open injury severity score as a predictor of outcomes of gustilo type III tibia fractures, a multicenter study
(Kampala International University, 2023-12) Okuku Maxwel Dancan
Gustilo type III tibia fractures, while common, present considerable challenges in management. The historical approach of emergent amputation has evolved with advancements in antibiotics, aseptic techniques, and microsurgery, shifting towards prioritizing cosmetic and functional restoration. Despite this shift, uncertainty persists regarding limb salvage versus amputation, prompting the development of various extremity scoring systems. Erroneous decisions in this regard can lead to unnecessary or delayed amputations, carrying substantial morbidity and mortality risks. Therefore, a predictive scoring system is essential to guide such critical decisions. This study aimed to assess the discriminatory accuracy of the Ganga Hospital Open Injury Severity Score (GHOISS) in predicting the need for amputation. Over a four-month period, a prospective cohort study enrolled 52 consecutive patients with 53 Gustilo type III tibia fractures from the emergency and orthopedic units of KIUTH and JRRH. Participants were evaluated using the GHOISS scoring system and subsequently managed according to established trauma protocols. Decisions on limb salvage or amputation were made independent of the GHOISS scores. Among 53 tibia fractures, 47 underwent salvage procedures, while 6 necessitated amputation (4 primary and 2 secondary cases). A GHOISS score of 13 demonstrated notable sensitivity and specificity in predicting amputation, with values of 83.3% and 91.5%, respectively. The area under the curve (AUC) for the GHOISS score was 0.933, highlighting its strong predictive capability. The GHOISS scoring system proves to be a dependable predictor of outcomes for Gustilo type III tibia fractures. Notably, a GHOISS score of 13 exhibited the highest sensitivity and specificity for anticipating the need for amputation. It should therefore be used to improve on clinical decisions in the care as well as prognostic counseling of these patients of patients with these injuries.
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Prevalence and Factors Associated with Overweight and Obesity among Adolescents in Selected Secondary Schools in Bushenyi-Ishaka Municipality, Western Uganda
(Kampala International University, 2021-11) Simon Odoch
Background: Childhood obesity has become a worldwide epidemic. Several non-communicable diseases are now being found among overweight and obese adolescents. There is lack of data on the burden of overweight and obesity, associated comorbidities in Bushenyi-Ishaka municipality. This study aims to investigate prevalence; factors associated with overweight and obesity among adolescents in selected secondary schools in Bushenyi-Ishaka municipality and determined the proportion of overweight and obese adolescents with hyperglycemia.
Methods: A school-based cross-sectional study was conducted. Multistage sampling technique used to randomly recruit 752 study participants aged 12 to 18 years with the use of interviewer administered structured questionnaires. Food Frequency Questionnaire, International Physical Activity Questionnaire and HEADSS assessment tool were adapted to assess dietary, physical activity and sedentary lifestyle, and psychosocial factors, respectively. Weight and height was measured twice and average calculated provided the difference between the two measurements does not vary by more than 0.5kg for weight or 0.5cm for height. Body Mass Index (BMI) was calculated by dividing weight by height in squared meter and interpreted as normal, overweight or obese using International Obesity Task Force BMI cut-off references for a given age and gender. A glucometer was used to measure fasting blood glucose; ≥ 5.6 mmol/L was considered hyperglycemia. Data analyzed using SPSS version 27.0. The prevalence of overweight and obesity were determined as a proportion. Binary logistic regression was used to determine factors associated with overweight and obesity taking a p-value < 0.05 at 95% confidence interval to be statistically significant. Hyperglycemia among overweight and obese adolescents was determined as a proportion.
Results: Of the 752 study participants, 563 (74.9%) were from private schools and 189 (25.1%) from public schools. Prevalence of overweight and obesity was 15% with overweight and obesity only being 14.1% and 0.9%, respectively. Out of 113 overweight and obese adolescents, 11 (9.7%) had hyperglycemia. Female gender (aOR = 10.17, 95% CI: 4.52-22.91, p < 0.001), urban residence (aOR 1.70, CI 1.12-2.53, p = 0.013), family history of obesity and overweight (aOR = 2.86, 95% CI: 1.62-5.05, p < 0.001), less than moderate to vigorous physical activity (aOR 2.82, 95% CI: 1.46-5.47, p = 0.002), and, unhealthy diet, (aOR = 2.91 95% CI: 1.53-5.53, p = 0.001) were independently associated with overweight and obesity. In addition, adolescents who received pocket money were more likely to be overweight or obese (aOR = 3.77, 95% CI: 1.47-9.66, p = 0.006).
Conclusion: This study found high prevalence of overweight and obesity with one in six adolescents being affected. One in 10 overweight and obese adolescents had hyperglycemia. Adolescents at high risk of obesity should be targeted for healthy lifestyle programs in secondary schools.
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MROP-Mesh versus Desarda technique for short-term surgical outcomes in open inguinal hernia repair at Kampala International University Teaching-Hospital: A randomized controlled trial
(Kampala International University, 2021-11) Lauben Amagara Kyomukama
Introduction: Surgical outcomes of open Inguinal hernia repairs dictate the best technique to use and tension free repair is the current standard of care. Mesh repair and Desarda techniques are tension free techniques and their outcomes are comparable. The dearth of data comparing affordable mesh and Desarda techniques limits choice in developing countries. This study compares short term surgical outcome of open inguinal hernia repair of MROP-mesh with Desarda techniques.
Methods: The study adopted a double blinded randomized clinical trial at KIUTH that followed up 66 Males aged 18-65 years with primary inguinal hernia who were recruited and randomly assigned to M-arm (32) and D-arm(34) for open inguinal hernia repair followed up for 14 days for surgical outcomes. Data was recorded using a questionnaire and analysed by Stata 14 . The difference in mean operative time, pain scores-(VAS) and complications were compared using unpaired-student t-test, Fisher‟s exact, Mann-whitney(U) and Kruskal-Wallis(H) tests as appropriate. The study was approved by KIU-REC-(Nr.UG-REC-023/202020), UNSCT-(UNCST/RC1/94812205) and Clinical trial registry-(PACTR202105846681553).
Results: The mean age of 66 males was 46±11 years, 4 years greater in M-arm and majority were illiterate (74.8%). There were risks of familial hernia (36.4%), smoking and alcohol (38%), moderate pain and average long duration of inguinal swelling of 83 months. The mean operative time (minutes) was longer for M-(M=60.78, SD=22.93) than D (M=51.44, SD =30.36) with a variance of 9.3 and p = 0.16 indicating no statistical significance between the two arms. There was moderate pain (D=2.86 ) for the first two days and mild to no pain at day 7 and 14. while many had acute pain (D-arm 80%, M-arm 74%), 5% (M) had haematoma, scrotal swelling (D=6%, M=18%), and only 2 (3.0%) respondents had surgical site infection with majority 53-(D=49%, M=47%) returning to work by end of day 14 follow up.
Conclusion: Statistically Desarda was comparable to Mesh repair and clinically number of sterile gauze pieces used is a predictor of intraoperative complications. The null hypothesis of this study is henceforth accepted.
Recommendation: Desarda-technique should be adopted as standard of care in hernia surgery in low-income countries besides affordable(MROP) mesh.
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Prevalence and factors associated with under nutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi District
(Kampala International University, 2021-10) Kumbowi Kumbakulu Patrick
Background: HIV-exposed children are vulnerable to undernutrition. Knowledge of feeding practices, prevalence and factors associated with undernutrition among HIV-exposed uninfected children remains the mainstay to elaborate efficient strategies, which can help to reduce the burden of undernutrition among this vulnerable group.
Methods: This was a cross sectional, descriptive and analytical study to determine the prevalence, feeding practices and factors associated with undernutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi District, Uganda. The study involved 245 mother-child pairs in four antiretroviral treatment clinics from May to June 2021. Questionnaire interviews were used to obtain socio-demographic, medical, and dietary factors data. A digital weighing scale, stadiometer and mid-upper-arm circumference (MUAC) tape were used to measure body weight, length, and MUAC of participants respectively. Undernutrition was defined by either a length-for-age or a weight-for-length or a weight-for-age below -2 SD of the 2006 World Health Organization growth standards for stunting, wasting and underweight respectively. Data were entered and analyzed using IBM SPSS 27.0 statistics for windows. The prevalence of undernutrition and feeding practices indicators were determined as proportions, whereas binary logistic regression was used to determine factors associated with undernutrition. A p-value <0.05 was considered for statistical significance at multivariable level.
Results: Of the 245 participants, 43(17.6%) had undernutrition. The prevalence of stunting, wasting and underweight was 11%, 5.3% and 6.5% respectively. Most study participants 235(95.9%) were initiated on breastfeeding during their first hour of life, and 215(87.8%) were exclusively breastfed for 6 months. However, 93(38%) of study participant did not receive an acceptable meal frequency and 188 (76.7%) did not have an acceptable dietary diversity score during the last 24 hours. The mean dietary diversity score was 2.9±0.4, 2.7±0.8, 2.6±0.5, and 2.6±0.6 for study participants with normal nutritional status, stunting, wasting, and underweight respectively. Only 4(4%) continued breastfeeding after 1 year of age. Among HIV-positive mothers, 108(78.4 %) had ever been advised on feeding practices. Factors that were significantly associated with undernutrition included young age of the mother (aOR=2.51, 95% CI: 1.12-5.62, p=0.024), low birth weight (aOR=2.85, 95% CI: 1.12-7.23, p=0.028), child’s history of illness in the past two weeks (aOR=1.84, 95% CI: 1.04-5.53, p=0.039), maternal viral load of ≥ 1000 copies/μL (aOR=3.4, 95% CI: 1.13-10.19, p=0.029) and maternal undernutrition (aOR=9.35, 95% CI: 1.99-13.69, p=0.001).
Conclusion: The prevalence of undernutrition among HIV-exposed uninfected children (6-18 months) in Bushenyi district was relatively low. The study revealed a high exclusive breastfeeding rate in the first 6 months, which may have offered a protective effect. On the other hand, complementary feeding practices were poor with regards to frequency and diversity. This study demonstrates the need for routine nutritional assessment of HIV-exposed uninfected children, especially those presenting with these risk factors
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Evaluation of the Effects of Galinsoga parviflora (Cav) Aqueous Leaf Extract on the Cerebellum During Mercury Exposure in Adult Male Mice
(Kampala International University, 2021-10) John Ayuba Tabakwot
Background: The cerebellum forms a major part of the brain and its function is to control all muscular movements and coordination. Injury or damage to the cells of the cerebellum may lead to conditions like; ataxia, Joubert syndrome, and many others. These injuries may be a result of traumatic brain injuries or toxic agents such as mercury, tin, and aluminum. For example, mercury exposure has been reported to be part of our daily lives, therefore it is important to understand the pathological implication that might follow these exposures and also with the help of a local herb; Galinsoga parviflora (GP) to find a cheap and readily available management solution to mercury toxicity in the cerebellum.
Objective: This study was designed to demonstrate the effects of Galinsoga parviflora (Cav) aqueous leaf extract on mercury-induced cerebellar damage in adult male mice.
Method: Twenty-five adult male mice of an average weight of 25g were randomly divided into 5 groups of 5 rats each (n=5). The animals in Groups 1-5 received oral administration of distilled water, 2.3mg/kg body weight of HgCl2, 2.3 mg/kg HgCl2 followed by GP extract (800mg/kg), GP extract (800mg/kg) followed by 2.3 mg/kg HgCl2 and GP extract (800mg/kg) followed by 2.3 mg/kg HgCl2 concurrently respectively. These treatments were followed by behavioral tests, euthanization of the animals through perfusion fixation and tissue samples were harvested for histological, histochemical and biochemical analyses.
Results: There was evidence of pyknotic cells, degenerating myelin, region of linear distribution of Purkinje cells in the cerebellum of group 2 animals. Also, these animals exhibited abnormal neuromuscular function and uncoordinated balance and posture. Furthermore, there was reduction in CAT (220.28±27.84) and SOD (43.25±13.28) concentration and increase in MDA (3.03±0.09) levels in the cerebellum of the mice. The animals in group 3 revealed reduced pyknotic cells, presence myelination in their cerebellum. Also, they showed neuromuscular function and coordinated balance and posture controls. Furthermore, there was significant increase in concentration of CAT (264.52±3.61) and SOD (50.0±4.08) and reduced in level of MDA in the cerebellum (2.96±0.20). Group 4 animals revealed evidence of less pyknotic cells, reduced linear distribution of Purkinje cells, evidence of myelination in the cerebellum. Also these animals exhibited neuromuscular functions and coordinated balance and posture controls. Furthermore, there was significant increase in concentration of CAT (299.25±13.49), reduction in concentration vii SOD (55.0±5.40) and increase in MDA (3.19±0.15) level in the cerebellum. Group 5 animals revealed evidence of relatively high normal pyramidal cell, shorter region of reduced linear distribution, normal axonal myelination of Purkinje fibers. Also the animals showed normal neuromuscular function, coordinated balance and posture, significant increase in concentration of CAT (275.4±16.04), SOD (76.75±2.36) and increase level of MDA(2.73±0.19) in the cerebellum.
Conclusion: In conclusion, the study revealed that mercury exposure in the cerebellum of mice caused pyknosis, reduced myelination in the axons, loss of neuromuscular function, loss of balance and coordination and reduced antioxidant activities. However, the introduction of Galinsoga parviflora in the cerebellum acted as a therapeutic agent against mercury toxicity in the cerebellum of adult male mice.