Introduction: Acute kidney injury (AKI) is a common and life-threatening complication of major trauma. Recognition is often delayed and management is frequently sub-optimal. We determined the incidence, risk factors and immediate outcomes of AKI in patients with major trauma at Mulago National Referral Hospital.Methods: This was a prospective study. We recruited adult patients with ISS of > 16. The KDIGO criteria was used to stage AKI. Serum creatinine was measured at baseline, 24, 48, 72 hours and on discharge from the study. Participants were followed up for seven days if not yet discharged. Bivariate and multivariate analysis was done using modified Poisson regression with robust standard errors.Results: 224 patients were recruited. The incidence was 67/1000 persons per day. The risk factors were male sex, delayed presentation, hypoglycemia at admission, RR=1.62 (95%CI 1.24-2.12) and non-operative management RR=1.39 (95%CI 1.02-1.89). Out of the 62 patients that died, 34 (54.8%) had AKI. The overall mortality rate was 39.5 patients per thousand per day.Conclusion: There was a high incidence of AKI among patients with major trauma. Efforts to reduce morbidity and mortality should be prioritized.Keywords: AKI=Acute kidney injury; major trauma; ISS = injury severity score.

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Introduction: Secondary peritonitis is the second leading cause of sepsis worldwide. Drug-resistance to peritoneal cavity bacterial infection remains a public health threat especially in resource limited settings of Africa including Uganda. This study was aimed at determining the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. Methods: This was a cross sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. After laparotomy, clinical samples were aseptically collected from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. Results: Majority of the patients were males (61.9%) with a mean age of 37.9(SD +/- 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organism at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570–8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95%CI = 1.232–7.099, p = 0.015) were independently associated with secondary peritonitis. Conclusion Imipenem, Amikacin, Ciprofloxacin and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital in order to minimise progression to secondary peritonitis.

The occurrence of gangrenous cholecystitis as a complication of typhoid fever is rare. This is a case study of a 7 year old that presented with fever and abdominal pain and later developed abdominal distension. She was later diagnosed with a gangrenous cholecystitis and gall bladder empyema.