Identification of early outcomes post stroke and their predictors is important in stroke management strategies. We prospectively analysed 30-day outcomes (mortality and functional ability) after stroke and their predictors among patients admitted within 7 days post event to a national referral hospital in Uganda. This was a prospective study of acute stroke patients consecutively enrolled between February and July 2014. Social demographics, clinical, laboratory, imaging characteristics, outcomes (all through 30 days), time of death were assessed using standardised questionnaires. Multiple regression was used to analyse the independent influence of factors on outcomes. Of 127 patients, 88 (69.3 %) had ischemic stroke and 39 (30.7 %) had hemorrhagic stroke. Eight (6.3 %) died within 7 days, 34 (26.8 %) died within 30 days, with 2/3 of deaths occurring in hospital. Two were lost to follow up. Of 91 survivors, 49 (53.9 %) had satisfactory outcome, 42 (46.1 %) had poor functional outcome. At multivariate analysis, independent predictors of mortality at 30 days were unconsciousness (GCS <9), severe stroke at admission and elevated fasting blood sugar. None of the patients with functional independence (Barthel index ≥60) at admission died within 30 days. Inverse independent predictors of satisfactory outcome at 30 days were older age, history of hypertension and severe stroke at admission. Acute stroke patients in Uganda still have high rates of early mortality and poor functional outcomes. Independent predictors of mortality and poor functional outcome were severe stroke at admission, unconsciousness, high fasting blood sugar, old age and history of hypertension.

BackgroundIntegrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda.MethodsIn a one year non-randomised controlled study, 127 stroke patients who had ‘usual care’ (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group). Patients were consecutively enrolled (controls first, intervention group second) into each group over 5 month periods and followed to 30-days post stroke. Incidence outcomes (mortality and functional ability) were compared using chi square test and adjusted for potential confounders. Kaplan Meier survival estimates and log rank test for comparison were used for time to death analysis for all strokes and by stroke severity categories. Secondary outcomes were in-hospital mortality, median survival time and median length of hospital stay.ResultsMortality within 7 days was higher in the intervention group compared to controls (RR 13.1, 95% CI 3.3–52.9). There was no difference in 30-day mortality between the two groups (RR 1.2, 95% CI 0.5–2.6). There was better 30-day survival in patients with severe stroke in the intervention group compared to controls (P = 0.018). The median survival time was 30 days (IQR 29–30 days) in the control group and 30 days (IQR 7–30 days) in the intervention group. In the intervention group, 41patients (32.3%) died in hospital compared to 23 (18.1%) in controls (P < 0.001). The median length of hospital stay was 8 days (IQR 5–12 days) in the controls and 4 days (IQR 2–7 days) in the intervention group. There was no difference in functional outcomes between the groups (RR 0.9, 95% CI 0.4–2.2).ConclusionsWhile implementing elements of a stroke-focused ICP in a Ugandan national referral hospital appeared to have little overall benefit in mortality and functioning, patients with severe stroke may benefit on selected outcomes. More research is needed to better understand how and when stroke protocols should be implemented in sub-Saharan African settings.Trial RegistrationPan African Clinical Trials Registry PACTR201510001272347

Falciparum malaria is known to cause alterations in the coagulation cascade, including disseminated intravascular coagulation. Microthrombotic complications are the best described; however, a number of cases of thrombosis involving larger vessels have been published in the literature. Herein, we describe the case of a woman with malaria associated with massive pulmonary embolism.

Background: The pandemic of COVID-19 has led to an upsurge of critically ill patients requiring advanced life support. Bacteria and fungi have been isolated as etiological agents for co-infections among COVID-19 patients in the intensive care unit (ICU). Co-infection has been associated with worse outcomes among COVID-19 patients in ICUs. The aim of this study was to determine the prevalence of co-infections and their antimicrobial susceptibility patterns among COVID-19 patients admitted to intensive care units in Uganda. Materials and Methods: A multi-center cross-sectional retrospective survey was carried out in Intensive Care Units (ICUs) in Mulago national referral hospital, UMC Victoria and TMR international hospital in Uganda. The records of 216 hospitalized ICU COVID-19 patients were purposively sampled using a standardized data abstraction tool. The collected data were double entered in Epi-data version 3.1 and exported to Stata version 17.0 for statistical analysis. Results: The prevalence of co-infections (bacterial and fungal) was 111(51.39%) with respiratory tract infections 57(51.35%) being the most prevalent. Staphylococcus aureus 23(28.75%), Citrobacter freudii 19(23.75%), Pseudomonas aureginosa 15(18.75%) and Klebsiella pneumoniae 10(12.50%) were the most frequently isolated bacterial species. The prevalence of multidrug resistant bacterial species was 75.95%. About 07/8(8.75%) of the bacterial species were extended spectrum beta lactamase or AmpC beta lactamase producers. Some of ESBL producers demonstrated susceptibility to Augmentin, Amikacin and trimethoprim. Augmentin 33/54(61.11%) and ceftriaxone 4/44(9.09%) had the highest and lowest overall antibiotic susceptibility respectively. About 31/111(27.93%) of the organisms were Candida albicans. The fungal species isolated had good overall susceptibility to most commonly used antifungal agents in the study setting. Conclusion: This study found a high prevalence of co-infections (bacterial and fungal). Respiratory tract infection was the most prevalent. There was an overwhelming burden of multidrug resistant infections with some extended spectrum drug resistant organisms isolated among COVID-19 patients admitted in the Ugandan ICUs. There is need for establishment of stronger policy measures in regards to antibiotic stewardship, antimicrobial surveillance and infection control to inform empirical antibiotic therapy and mitigate the spread MDR bacteria and antibiotic drug resistance among COVID-19 patients.