Master of Medicine in Surgery

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    Factors associated with serum electrolyte imbalances and unfavorable Outcome among Traumatic Brain injury Patients at Mbarara Regional Referral Hospital
    (Kampala International University, 2023-05) Sandra Nabukalu
    Introduction: Electrolyte abnormalities have for long been a common observation among patients with brain lesions. Traumatic brain injury (TBI) is an important global public health concern. TBI patients with abnormal serum electrolytes show a delay in healing, increase in length of hospital stay (LOS) and a high mortality. Despite this, very few studies have been done on factors associated with this unfavorable outcome and none about electrolyte imbalances in Uganda. This study aimed at assessing the factors associated with serum electrolyte imbalances and unfavorable outcome among Traumatic Brain Injury patients at Mbarara Regional Referral Hospital (MRRH). Methods: This study was partly cross-sectional and partly prospective cohort done at MRRH. TBI Patients aged 18-65 years admitted at MRRH were enrolled. Serum electrolytes were measured at admission and 48 hours later. The patients were followed up to discharge and extended Glasgow outcome score determined in addition to LOS. Analysis was done using SPSS version 22. Results: During the study period, 254 patients with TBI were enrolled, majority of whom were males 226 (93.4%).Overall, 119(49.2%) patients had at least one electrolyte abnormality at one point during the study. The commonest electrolyte imbalances were hyponatremia and hyperchloremia. Hyponatremia at admission was independently associated with hyperthermia (AOR=2.531, CI=1.047-6.117, P=0.039) and being aged 46 years or above (AOR=2.784, CI= 1.006-7.706, P=0.049). Hypernatremia at admission was independently associated with being aged 45 years and (P=0.028, AOR=10.631, CI=1.288-67.747), Tachycardia at admission (P=0.011, AOR=14.642, CI=1.869-44.682) and hyperthermia at 48 hours (P=0.004, AOR=5.533, CI=1.321-18.620).Hyponatremia at 48 hours was independently associated with GCS < 13 at admission (AOR=3.671, CI=1.131-11.923, P=0.030).Hypernatremia at 48 hours was independently associated with age group 31-45 (P=0.023) and 46+ (P=0.027), bradycardia (P=0.019) and tachycardia (P=0.044) at admission, Low SPO2 at admission (p=0.001), Low SPO2 at 48 hours (P=0.014) and GCS 9-12 at 48 hours (P=0.025).Hypokalemia at admission was independently associated with systolic hypotension at admission (AOR=9.050, CI=1.477- 55.458, P=0.017). Hyperkalemia at admission was independently associated with systolic hypotension at admission (AOR=18.557, CI=1.973-74.513, P=0.011). Hypokalemia at 48 hours was independently associated with presenting after 24 hours (AOR=4.854, CI=1.046-22.523, P=0.044). Hyperkalaemia at 48 hours was independently associated with hypotension at 48 hours (P=0.035). Hypochloremia at admission was independently associated with hyperthermia at admission (AOR=6.847, CI=2.407-19.479, P=<0.001).Hyperchloremia at admission was independently associated with chronic alcohol use (P=0.031), presence of hypotension at admission (P=0.005), and presence of hyperthermia at 48 hours (P=0.047).Hypochloremia at 48hours was independently associated with having a GCS
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    Quality Of Life and Associated Factors among Adult Patients ≥ 3 Months Following Traumatic Brain Injury in Western Uganda
    (Kampala International University, 2023-05) Kavuma Daniel
    Introduction Traumatic brain injury is a major cause of disability and death, especially in individuals under the age 40 years. Traumatic brain injury (TBI) poses a great global public health problem yet it has been least attended to by researchers and policy makers in low and middle-income countries (LMICs). Survivors are left with temporary or permanent disabilities. Scientists, researchers and clinicians who work in the Traumatic brain injury rehabilitation field have appreciated the importance of an individual’s QoL as a critical indicator of the outcome following TBI. Research and clinical practice are now prioritizing on the QoL as an outcome measure. It is a useful frame of reference to measure outcome after TBI (Sukraeny et al., 2013). Objective: The main aim was to study the quality of life and its associated factors in adult patients 3 months and more following TBI at KIUTHWC, MRRH. Methods The research design was a hospital-based cross-sectional descriptive and analytical study of 217 head injury survivors admitted, managed and discharged at KIUTH-WC and MRRH. Both the baseline characteristics and QoL data were collected just once as participants were interviewed in the outpatient clinics and some via phone calls. Results 217 patients were enrolled and the mean age was 37 (SD=15.723), dominated by males (88.5%) and females (11.5%). Their median time after trauma was 12 months and median length of hospital stay was 6 days. With Qol, 63.6% had good Qol, and 14.7% had low QoL. The mean Qol was 75.7% (SD=21.03). The domains of Thinking, emotions, independence and autonomy had the most significant impact on the Qol. At Bivariate analysis, patients who were business people were 8 times more likely to have good quality of life following brain injury compared to farmers, cOR=0.12,95%CI 0.02-0.96. At Multivariate analysis, age, length of hospital stay, time after trauma were significant predictors of quality-of-life following Brain Injury. aOR=4.25, 95%CI 1.40-12.92 (Age), OR=13, 95%CI (0.02-0.34) for length after trauma. Conclusion It was found out that the majority of the participants were young and middle age who eventually contributed to an overall good Qol for this study. Time after trauma had the most significant impact on the quality of life after traumatic brain injury TBI given the fact that a longer time after TBI was sufficient for recovery. A long follow up period is thus associated with a better Qol as well as the ability of the survivors to return to their work and daily life activities.
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    Anatomical patterns and factors associated with quality of life among patients managed for upper limb fractures in Uganda: A Multicenter Study
    (Kampala International University, 2024-01) Opio Morris
    Introduction: Upper limb fracture constitutes a high percentage to emergency department visit. These injuries have been reported to impact the patients wellbeing, yet no study has addressed this subject matter our setting. The purpose of the study was to determine the anatomical patterns and factors associated with quality of life among patients managed for upper limb fractures at Kampala international university teaching hospital (KIU-TH), Lira regional referral hospital (LRRH) and Mubende regional referral hospital (MRRH). Methods:It was a prospective cohort which enrolled patients with upper limb fractures at KIU-TH, LRRH and MRRH. The anatomical patterns were determined by clinical evaluation and radiology, while the WHO quality of life questionnaire (WHOQOL-BREF)was used to assess the QoL. The data was analysed by SPSS version 26 and poison regression used to determine the factors associated with quality of life. Results: Of the 101 participants enrolled, majority were males 60(59.4%) aged between 18-30 years 53(52.5%). The most commonly injured bones were the radius 33(32.7%) and humerus 26(25.7%). The overall median score for quality of life was 44.3/100, with the maximum score obtained being 71.4/100 and the lowest score being 26.1/100. Only 26 participants had a good life style accounting for 25.7% of the participants while 25 (24.8%) had a poor quality of life. The lowest median quality of life score was reported in general health (Median=37.5, IQR=37.5-50.0) while the highest median quality of life score was reported in social relationships (Median=50.0, IQR=41.7-58.3). The factors that significantly decreased the chances of having a good quality of life were age above 45 years (aRR=0.769, CI=0.610-0.969, P=0.026), obesity (aRR=0.796, CI=0.655-0.967, P=0.022) and head injury (aRR=0.837, CI=0.721-0.971, P=0.019). Conclusion:The quality of life following upper limb fractures was generally poor. Following upper limb fracture management, attention should be focused at improving the life style among these patients, with focus on improving general health mainly among the elderly, the obese and those with head injuries
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    Immediate and late outcome of patients with peritonitis using the mannheim index score at Fort Portal Regional Referral Hospital
    (Kampala International University, 2023-03) Odongo Samuel Oledo
    Background: Peritonitis significantly is an intra-abdominal pathology that is so commonly encountered by surgeons in Uganda, and it is associated with significant morbidity and mortality as one of the common post-operative outcomes. The study sought to invest the prevalence of peritonitis, prediction peritonitis severity using the Mannheim index score and the associated factors with immediate and late post-operative outcome. Methods: This was a descriptive hospital study design and a questionnaire was used to collect data on the study variables. Data was collected from a total of 64 patients presenting with signs and symptoms of peritonitis. Analysis was done using SPSS version 21 and frequencies, percentages, Odds ratios, p values were used to present the findings. Results: The prevalence of peritonitis was 23.1% at FRRH and most were diagnosed with diffuse peritonitis. Mannheim index score was found to be a liable predictor of outcome where the accuracy of MIS was 97% as 3 patients were classified under severe died and majority of the patients experienced good outcome. Factors such as age(p=0.053) 36-49years, rural residence(p=0.037), alcohol consumption (0.052), comorbidities (0.033) duration before reporting complication (4 days [0.003]), abnormal pulse rate (0.006), and organ failure(p=0.002) were statistically associated with unfavourable immediate and late outcomes such as death (14.1%), prolonged hospital stay (39.1%), burst abdomen(6.3%) severe pain(25%) and surgical site infections(35.9%) Conclusion: The study concludes that other than delay in reporting complication relating peritonitis, factors such as age, residence, alcohol, comorbidities, pulse rate and organ failure affect the favourable post operative outcome following management of peritonitis. Medical personnels should as well give attention to other factors if quality of life post operative is a goal.
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    Prevalence, anatomic-pathologic findings, and associated factors of non-traumatic ilea perforations: A multicenter study
    (Kampala International University, 2023-05) Musa Abbas Waziri
    Background: Non-traumatic ileal perforation is a complication of typhoid fever disease in LMICs due to burden of poor hygiene practice, HIV infection, and late health seeking behaviors of individuals in the community. However, there is paucity in information on the socio-demographic, clinical, environmental, infrastructural factors, and anatomic-pathologic findings influencing the prevalence of non-traumatic ileal perforations in this region. Objective: To determine the prevalence, associated factors, and anatomic-pathologic findings of non-traumatic ileal perforation at selected KIU teaching sites hospitals in Uganda. Methodology: Cross sectional study of 149 consecutive sampled participants, using a structured checklist. We conducted bivariate and multivariate analyses using SPSS v21.0 IBM, regarding p<0.02, and 0.05 respectively as statistically significant levels. Results: In this study, non-traumatic ileal perforation was (28.9%), of all gut perforation, common amongst males (69.7%) peasants/farmers (41.6%) of rural residence (22.1%). Majority of participants were of typhoid perforations (79.1%). Being HIV positive person was associated with higher odds of developing NTIP as compared to those with negative HIV status AOR 8.344 p = 0.015 (p<0.05). Also the use of open (-sheltered), and closed (+sheltered) pit latrines had odds AOR 12.971, p = 0.004, (p < 0.05), and (AOR=5.805, CI=1.196-28.172, P=0.029) of developing non-traumatic ileal perforation as compared to those with water flash toilet respectively. Conclusion In this study, prevalence of non-traumatic ileal perforation was common amongst male, peasants of rural residence, being HIV positive, use of (-sheltered) and (+sheltered) pit latrine was associated with high odds of developing non-traumatic ileal perforation compared to the use of water flush toilet, and being HIV negative. There was no statistical significant relationship between anatomic and pathologic findings...