College of Health Sciences (CHS)
http://hdl.handle.net/10570/2
2024-03-29T01:29:02Z30 day in-hospital patient mortality after ICU discharge and associated factors : a retrospective cohort study in selected tertiary hospitals in Kampala
http://hdl.handle.net/10570/8864
30 day in-hospital patient mortality after ICU discharge and associated factors : a retrospective cohort study in selected tertiary hospitals in Kampala
Nantongo, Betty
Background: Intensive care medicine is rapidly growing because critical illness is a major component of the global burden of disease especially in LMICs. We retrospectively evaluated the 30 day In-hospital patient mortality after ICU discharge and associated factors. Methods: We conducted a retrospective multicentre Cohort study on all patients that were discharged alive from the ICU at three tertiary hospitals in Kampala- Uganda, patient records discharged between January 2018 to December 2019 were reviewed during their hospital stay to fill the data extraction tool and followed up. In-hospital mortality after ICU discharge as primary outcome. Results: In total 711 patients were included with mean age of 42 years and 56.4% were male. A total of 106/711 patients died after ICU discharge giving a mortality of 14.9% (95% CI: 12.4-17.7). Most (86/711) patients died within the first 20 days with a 0.802 survival probability and were mostly above 40 years. The median number of hospital stay after ICU discharge 7 days (IQR: 5-11). Multivariate analysis identified presence of comorbidities, Respiratory disorder at ICU admission and GIT disorder at ICU admission and inotropic/vasopressor support to be associated with patient mortality after ICU discharge while Tracheostomy placement was found to be protective. Conclusion: The 30-day in hospital patient mortality rate after ICU discharge was high compared to that in high income countries. Most in-hospital patient deaths after ICU discharge occurred during the first 20 days. A prospective study is needed to further explore In-hospital patient mortality after ICU discharge and associated factors.
A dissertation to be submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirement for the award of the Degree of Masters of Medicine (Anaesthesiology) of Makerere University
2021-01-25T00:00:00ZAbdominal sonographic changes among HIV-TB co-infected adult patients initiating highly active antiretroviral therapy at Mulago Hospital Complex.
http://hdl.handle.net/10570/4354
Abdominal sonographic changes among HIV-TB co-infected adult patients initiating highly active antiretroviral therapy at Mulago Hospital Complex.
Jabo, Christian Roy Thomas
Human immunodeficiency virus (HIV) infection increases the risk for infection with Mycobacterium tuberculosis (TB). In HIV-TB co-infected patients, abdominal tuberculosis accounts for 11-16% of extra pulmonary cases. Abdominal sonographic changes following initiation of Highly Active Antiretroviral Therapy (HAART) in these patients may be due to the response to anti-Tuberculous drugs and HAART, due to adverse reactions to these treatments or due to other associated co-morbidities. The changes may show improvement of abdominal features during treatment or worsening as a result of paradoxical TB-IRIS. They may also be new findings due to other opportunistic infections. Ultrasound imaging is a useful auxiliary investigative modality in the management of HIV-TB co-infected patients initiating HAART and it can demonstrate these abdominal sonographic changes. However, there is no recent research on its role in the management of HIV-TB co-infection in Uganda.
Objective
The study aimed at describing the abdominal sonographic findings among HIV-TB co-infected adult patients initiating HAART at Mulago Hospital Complex.
Methodology
A prospective descriptive study design was used. This study was nested in a prospective observational cohort study whose aim was to determine the incidence and predictors of clinical and immunological outcomes in adult patients co-infected with TB-HIV. It was conducted in the Department of Radiology at Mulago Hospital, the national referral hospital. Adults with HIV-TB co infection eligible for HAART were enrolled in the study. Serial abdominal ultrasound scans using low frequency (2-5MHZ) and high frequency probes (7-12MHZ) were performed. Data were collected on structured questionnaires, entered into a computer using Epi data version 3.1 and analysed using Stata version 11 with the help of a statistician.
Results
Eighty nine patients were enrolled and had a baseline ultrasound scan, 70 (78.7%) patients had a scheduled follow up scan and 10 (11.2%) had an ultrasound scan during an unscheduled visit. 9 patients (10.1%) were lost to follow up of whom 6 patients died (66.7%) while 3 (33.3%) did not return for the scheduled scan. 65.2% were males and 34.8 % were females giving a male to female ratio of 1.9:1. The age range was from 20-62 years and the median age was 32 years.
There was no statistically significant difference in the abdominal sonographic findings at base line and 4 weeks after initiating HAART. Clinical features of abdominal pain and abdominal distention were significantly associated with development of abdominal sonographic changes while abdominal pain was the only symptom significantly associated with worsening of the abdominal sonographic changes (a OR=6.0, 95% CI=1.106-13.552 and a p value=0.038) on follow up or on development of symptoms of TB-IRIS.
Fourteen patients had normal abdominal scans while 75 had features suggestive of abdominal TB on baseline scan like lymphadenopathy, hepatosplenomegaly and splenic nodules. Fourteen patients had features suggestive of TB-IRIS on the follow up and unscheduled scans. Co-morbidities like nephropathy, splenic candidiasis and carvenous hemangiomas were diagnosed.
Sonographic changes observed in the abdomen were resolution of splenic infarction, regression of splenic abscesses, appendicitis, prostatic abscess, ascites, lymphadenopathy, cholecystitis, splenomegaly and hepatomegaly.
Conclusions
There is an increased incidence of HIV-TB co-infected patients with sonographic features which may be suggestive of abdominal tuberculosis at baseline scan.
Worsening abdominal sonographic changes within 4 weeks of initiating HAART tend to be associated with paradoxical TB-IRIS.
Abdominal pain and distention are associated with development of abdominal sonographic changes.
Abdominal pain is significantly associated with worsening of abdominal sonographic features on follow up visits.
There is no statistically significant difference between abdominal sonographic features at baseline and follow up 4 weeks after initiating HAART.
Recommendations
A study designed to establish the clinico-sonographic-pathological correlation and the schedule for follow up scans is highly recommended.
Follow up abdominal sonography should be delayed beyond 4 weeks unless patients develop new symptoms or worsened symptoms.
A screening ultrasound examination for TB-IRIS should be performed in all HIV-TB co-infected on treatment who develop abdominal pain.
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine Degree in Radiology of Makerere University
2014-01-01T00:00:00ZThe abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
http://hdl.handle.net/10570/1277
The abdominal sonographic features of burkitt's lymphoma in patients seen at Uganda Cancer Institute, Mulago Hospital, Kampala
Kwitonda, Pascal
INTRODUCTION:
Burkitt lymohoma is a B-cell lymphoma presenting in three main clinical variants: the endemic, the sporadic and the immunodeficiency-associated variants.
In Uganda, Burkitt’s lymphoma represents 50-70% of childhood cancers presenting mainly as facial tumour. Diagnosis depends on tissue examination. Imaging provides very useful diagnostic and staging information. Characteristically abdominal BL sonographically presents as well defined solid hypoechoic mass with mass effect; they lack calcifications and are a vascular on colour Doppler study. Ultrasound therefore plays an important auxiliary role in early detection and diagnosis of this potentially curable tumour and can be used to predict the prognosis.
OBJECTIVES:
The major objective of the study was to describe the sonographic features of BL and to relate them with the clinical features and laboratory findings in order to determine the prognostic benefit of abdominal ultrasound in patients with BL at the UCI-Mulago hospital.
METHODOLOGY:
This case series was conducted In UCI and Department of Radiology-Mulago hospital from march 2009 to September 2009. Sixty (60) patients with confirmed BL had abdominal ultrasonography done before initiation of chemotherapy and at one month after initiation of chemotherapy.
RESULTS:
Sixty (60) patients participated in the study. The age range was 3-18 years with a mean of 7.2 and standard deviation of 2.98. The peak incidence was between 5-9 years. There were 43 (71.7%) males and 17(28.3%) females. Facial bone tumours remained the commonest clinical finding however, the commonest single presenting compalit was palpable abdominal mass with pain in 31(51.7%) patients. Abdominal ultrasound showed that 40 (66.7%) of all patients had intra abdominal masses. Forty four (73.3%) patients had the tumours involving other parts of the body. Mpst patients presented with stage D disease and therefore had poor prognosis.
The commonest ultrasound findings were multiple lobulated heterogeneous hypoechoic abdominal masses in 40 (66.7%) patients. Of these masses 20(33.3%) were in the kidneys. Follow-up abdominal ultrasound showed that 32(80%) patients had tumour regression after one month of induction.
CONCLUSION:
• Abdominal ultrasound was able to demonstrate greater disease extent than clinical evaluation, thus highlighting the value of imaging in tumour staging and follow-up of patients.
• This study showed more cases of abdominal BL involvement than previously seen in our patients, possibly due to better imaging facilities now.
• Burkitt’s lymphoma should be strongly suspected in a child presenting with large lobulated hypoechoic intra-abdominal mass and histological diagnosis must be established as soon as possible.
• Serum LDH levels were very high in patients with large and multiple tumour sites involvement but decreased as the tumour mass regressed.
RECOMMENDATIONS:
• Follow up abdominal ultrasound should be done after one month of treatment in order to assess early response to chemotherapy.
• A bigger study should be done to comprehensively assess the role of ultrasound and serum LDH levels in follow up and determination of prognosis in BL patients.
A dissertation submitted in partial fulfillment of the requirements for the award of a Master of Medicine in Radiology of Makerere University.
2009-10-01T00:00:00ZThe academic alliance for AIDS care and prevention in Africa
http://hdl.handle.net/10570/223
The academic alliance for AIDS care and prevention in Africa
Quinn, Thomas C.
In the continent of Africa, AIDS is the leading cause of death, responsible for over 20% of all fatalities. To date, over 16 million people in Africa have died from AIDS, and approximately 26 million or 70% of the world’s total of HIV infected people reside in sub-Saharan Africa. Howe ve r, little or no treatment, either for HIV infection itself or for its complications, is available to HIV infected Africans. This inequity in care between Africa and western countries has been attributed to lack of infrastructure, poverty, lack of financial support from developed countries, insufficient health care delivery systems, lack of knowledge by African physicians on the use of these drugs, insufficient laboratory support,political inaction, and many other factors. Although increasing attention has been focused on the problem, particularly in the lay press, and although pharmaceutical companies have reduced the cost of their drugs, most Africans still cannot afford these medicines, and little has been done to bring good clinical care to the millions of HIV infected Africans. To address this problem, a new organization was formed in June 2001 called "The Academic Alliance for AIDS Care and Prevention in Africa," led by a group of Ugandan physicians from Makerere University and the Infectious Diseases Society of America with HIV/AIDS care experts from North America.
2001-11-01T00:00:00Z