Background: Prolonged post-operative ileus is associated with increased risk of other complications, length of hospital stays and health care related costs. Chewing gum has been shown to reduce duration of ileus in many elective surgeries, but there is a paucity of randomised controlled trials (RCTs) on its effect on duration of ileus among patients undergoing emergency surgery, specifically patients with peritonitis. The aim of this study is to determine the effect of chewing gum on duration of postoperative ileus following laparotomy for gastroduodenal perforations.Methods: This will be a randomised controlled trial done in 3 hospitals. Fifty-two patients will be randomised to 2 groups. Group A will receive chewing gum in addition to routine care, whereas group B will receive routine care only. The duration of postoperative ileus in the two groups which is the primary outcome, will be compared using the independent samples t-test in SPSS version 22. The length of hospital stay, in-hospital morbidity and mortality will be the secondary outcomes. This trial has been approved by Kampala International University research and Ethics committee (Ref No. KIU-2021-60) and Uganda national council of science and technology (Ref No. HS1665ES). Retrospective registration with the research registry has also been done (UIN: researchregistry8565). Highlights• Prolonged post-operative ileus significantly contributes to adverse surgical outcomes• Chewing gum has been shown to reduce duration of ileus in many elective surgeries• There is paucity of RCTs on role of chewing gum following surgery for peritonitis
Introduction Chest trauma is one of the most important and commonest injuries that require timely diagnosis, accounting for 25–50% of trauma related deaths globally. Although CT scan is the gold standard for detection of haemothorax, it is only useful in stable patients, and remains unavailable in most hospitals in low income countries. Where available, it is very expensive. Sonography has been reported to have high accuracy and sensitivity in trauma diagnosis but is rarely used in trauma patients in low income settings in part due to lack of the sonography machines and lack of expertise among trauma care providers. Chest X-ray is the most available investigation for chest injuries in low income countries. However it is not often safe to wheel seriously injured, unstable trauma patients to X-ray rooms. This study aimed at determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting. Methods This was an observational longitudinal study that enrolled 104 study participants with chest trauma. Informed consent was obtained from all participants. A questionnaire was administered and eFAST, chest X-ray and tube thoracotomy were done as indicated. Data were analysed using SPSS version 22. The sensitivity, specificity, predictive values, accuracy and area under the curve were determined using thoracostomy findings as the gold standard. Ethical approval for the study was obtained from the Research and Ethics Committee of Kampala International University Western Campus REC number KIU-2021-53. Results eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy. Conclusion This study revealed that eFAST was more sensitive at detecting haemothorax among chest trauma patients compared to chest X-ray. All patients presenting with chest trauma should have bedside eFAST for diagnosis of haemothorax.
Introduction Burn injury is a critical and under-recognized public health issue that affects people all over the world. Majority of the burns occur in low and middle income countries like Uganda. There is paucity of data relating to length of hospital stay among burn patients managed in hospitals with no burn units, yet this constitute a big percentage of hospitals in low income countries. This study was aimed at determining the predictors of length of stay at 3 hospitals in resource limited setting. Methods This was a prospective cohort multicentre study that enrolled 101 burns patients with moderate and severe burns admitted in 3 tertiary hospitals in western Uganda. Follow up was done till to discharge, length of hospital stay and its predictors determining using logistic regression in SPSS version 26. Results Of the 101 participants, the mean age was 21.3 (SD = 16.8) years. Majority were males (69.3%) from a rural setting (61.4%) and were accidentally burnt (95.0%) from home (75.2%). The mean length of hospital stay was 9 days with a standard deviation of 5.7. At multivariate level of analysis, the variables that independently predicted increased length of hospital stay were time to medical attention (AOR = 14.912, CI = 2.743–81.079, P = 0.002), burn severity (AOR = 6.173, CI = 1.392–27.371, P = 0.017) and type of procedure done (AOR = 0.047, CI = 0.009–0.245, P < 0.001). Conclusion This study revealed that the length of hospital stay was comparable to that seen in other studies. The factors independently associated with increased length of hospital stay were; time to medical attention, burn severity, and type of procedure done. Measures to ensure timely medical attention can reduce the length of stay among patients with burns even in the absence of a burn unit.
Introduction The incidence of road traffic accidents (RTAs) is on the rise contributing to the global burden of mortality as a major global health threat. It has been estimated that 93% of RTAs and more than 90% of the resulting deaths occur in low and middle income countries. Though death due to RTAs has been occurring at an alarming rate, there is paucity of data relating to incidence and predictors of early mortality. This study was aimed at determining the 24 h mortality and its predictors among RTA patients attending selected hospitals in western Uganda. Methods This was a prospective cohort that consecutively enrolled 211 RTA victims admitted and managed in emergency units of 6 hospitals in western Uganda. All patients who presented with a history of trauma were managed according to the advanced trauma life support protocol (ATLS). The outcome regarding death was documented at 24 h from injury. Data was analyzed using SPSS version 22 for windows. Results Majority of the participants were male (85.8%) aged 15–45 years (76.3%). The most common road user category was motorcyclists (48.8%). The 24 h mortality was 14.69%. At multivariate analysis, it was observed that a motorcyclist was 5.917 times more likely to die compared to a pedestrian (P = 0.016). It was also observed that a patient with severe injury was 15.625 times more likely to die compared to one with a moderate injury (P < 0.001). Conclusion The incidence of 24 h mortality among road traffic accident victims was high. Being motorcycle rider and severity of injury according to Kampala trauma score II predicted mortality. Motorcyclists should be reminded to be more careful while using the road. Trauma patients should be assessed for severity, and the findings used to guide management since severity predicted mortality.
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