Background Despite the fact that traumatic expansive intracranial hematomas (EIH) are frequent, it is debatable whether the timing of surgery affects the prognosis of patients. The study assessed the effect of timing to surgery on outcomes among adult patients with EIH at Mulago National Referral hospital (MNRH). Methods A prospective study was conducted among adult TBI patients with intracranial hematoma during a period of 1 year and follow up for 6 months. Participants were grouped into two arms based on the early (within 24 hours) or late (over 24 hours) surgical evacuation of EIH. The Kaplan–Meier survival curve and log-rank test were used to test for differences in survival status among groups. The level of significance was determined at a p-value of < 0.05. Results The analysis covered 324 individuals in all, and 10.2% of them died. Majority of patients (59.6%) had delayed surgery. Patients who underwent early surgery within 24 hours of accident had a median time to mortality of 2 days while those who underwent surgery more than 24 hours had a median time to mortality of 4 days (p=0.004). Patients who underwent early surgery had a median LOS similar to those who had late surgery of 2 days(p=0.278). The overall survival was 46.6%, 95% CI= (17.0 to 71.9). The survival was significantly influenced by QoLIBRI, GOS, SDH, SAH, contusion. Among the survivors, 73.8% were in good functional outcome at discharge. Surgical timing groups were different according to mortality, QoLIBRI at 180 days, which was on average lower in the late surgery group, and complications, which were higher in the same group. Delayed surgery was more associated with posttraumatic seizures (PTS), infection, bleeding, pneumonia, paralysis, nausea, vomiting and decompressive craniectomy. Conclusion Early surgery was associated with early mortality, but was neither associated with shorter LOS nor with better survival. Late surgery was associated with lower long-term QoLIBRI, higher complication rate. This study demonstrates that there are still differences in outcome about when to operate. Further high-quality studies are needed to solve this disparity.
Background There has been a significant paucity of literature reporting on the burden, risk factors, neurosurgical outcomes for expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) in Uganda and related low middle income countries. This research determined the burden, risk factors, neurosurgical outcomes in Uganda EIH patients. Methods A mixed methods study design was conducted among TBI adult patients with intracranial hematoma who underwent surgical evacuation during a period of 18 months. In analysis, univariate, bivariable and multivariable, cox regression analyses, Kaplan Meir survival curves, log rank test were sequentially conducted at p-values of <0.2 and 0.05, at a 95% Confidence interval (CI) in respective order to assess factors associated with EIH, surgical outcomes. Results Of the 324 patients with intracranial hematomas [80.6% male, mean age 37.5 (17.4) years], 192 (59.3%) had EIH resulting in a proportion of 0.59 (95% CI: 0.54 to 0.65). At multivariate model, age group between 39 to 48 PR =1.54 (95% CI 1.20 to 1.97; P = 0.001), age above 48 years PR =1.56 (95% CI 1.23 to 1.98; P <0.001), smoking PR =1.21 (95% CI 1.00 to 1.47; P = 0.048), having severe systemic disease PR =1.36 (95% CI 1.14 to 1.64; P = 0.001), and presence of swirl sign PR =2.26 (95% CI 1.29 to 3.95; P = 0.004) were found to be risk factors for EIH among patients with TBI. The Kaplan Meier 16 months mortality was 53.4%, 95% CI= (28.1 to 85.0). At multivariate Cox regression, the predictors of mortality were young age, MAP above 95 mmHg, low GCS, complication such infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, ASDH, contusion, and EIH Conclusion EIH is common in Uganda with a prevalence of 59.3% and 53.4 % of the Kaplan Meier mortality. Increased age above 39 years, smoking, having severe systemic disease and presence of swirl sign are risk factors. Old age, MAP above 95 mmHg, low GCS, complication such infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality.
Case presentationPresenting complaint: A 36-year-old woman in reproductive age has been referred to our hospital with a history of abdominal distension, and discomfort for the last 4 years.
Background During its first wave of COVID-19 infection in sub-Saharan Africa, there was insufficient understanding of the pandemic among frontline health workers. This study was carried out to determine the knowledge, attitude, and practices (KAP) of frontline health workers (HWs) towards COVID-19 in Africa and their related factors. Methods This was a multicenter online cross-sectional study conducted between April 2020 and July 2020 using a Google survey link among frontline HWs involved in the COVID-19 response in 26 African countries. Bivariate and multivariate logistic regression were used to analyse the determinants of KAP. Data were analyzed using STATA ver 16; all tests were two-sided with 95% confidence interval. Results Five hundred and seventeen participated in this study from 26 African countries; 289 (55.9%) were male and 228 (44.1%) female. Most of HWs, 379 (73.3%) showed poor knowledge about COVID-19 infection and preventive measures. In contrast, majority of them showed good attitude (89%) and practice (90.3%) towards prevention of COVID-19 infections. Knowledge varied among countries; Uganda had the greatest number of HWs with good knowledge (OR: 28.09, p<0.0001) followed by Ghana (OR=10.92, p=0.001) and DRC (OR: 4.59, p=0.015). The cadre of HWs also influenced knowledge; doctors were the most knowledgeable as compared to other cadres (OR: 3.4, p= 0.005). Attitude and practice were both influenced by HWs country of workplace and their cadre (p<0.05). Conclusion Majority of the frontline HWs in the African region had an overall good attitude and practice towards COVID-19 infection and practice measures despite relatively poor knowledge. The KAP is influenced by HWs country of workplace, their cadre. The knowledge of HWs in Africa should be increased to concourt with their attitude and practice to reduce the burden of intra-hospital transmission of the COVID-19.
Background: Hypernatremia is a common electrolyte imbalance observed in patients with traumatic brain injury (TBI) and it commonly leads to poor outcome. However, the consequence of hypernatremia on occurrence of expansive hematoma (EH) is not well established, though there is limited information on the burden of EH among TBI patients and associated risk factors. This study therefore assessed the proportion of hypernatremia and its correlation with EH among TBI patients at Mulago National Referral Hospital (MNRH), Kampala, Uganda. Methods: A prospective cohort study was conducted among TBI patients with intracranial hematoma undergoing surgical evacuation during a period of 16th June 2021 to 17th June 2022. A total of 332 patients were prospectively recruited. Demographic, clinical, laboratory and radiological data were captured using the Research Electronic Data Capture (Redcap) system. Patients were monitored for hematoma enlargement complications. The independent outcome was the sodium level (Na) > 145. The dependent outcomes were hematoma enlargement of over 33% evidence by two CT scans (baseline and follow up). Univariate and multivariate analyses were used to identify variables associated with hematoma enlargement. Results: 184 participants (55.4%) had expansive hematomas identified on CT scan resulting in a proportion of 0.55 95% CI (0.50 to 0.60). Hypernatremia was detected in 80 patients (25.2 %) within 24 hours of admission. At multivariate analyses, the results showed that only hypernatremia PR =1.56 (95% CI 1.17 to 2.10; P=0.003) was found to be a risk factor for expansive hematomas among patients with TBI. Conclusion: Hypernatremia is common with a prevalence of 25.2.8% among TBI patients. Patients with hypernatremia have 1.56-times higher risk of developing a EH when compared to patients who had no hypernatremia. These findings imply routine plasma sodium levels monitoring and could form the basis for establishing a blood chemistry control protocol for such patients in remote settings.
Background Trauma-induced coagulopathy (TIC) is a common problem among traumatic brain injury (TBI) patients which may contribute to expansive intracranial hematoma (EIH). However, there is limited evidence on whether raised international normalized ratio (INR) and activated partial thromboplastin time (aPTT) which may contribute to this problem. The study assessed the effects of changes in INR and aPTT on EIH among TBI patients at the Mulago National Referral Hospital (MNRH), Kampala, Uganda. Methods A cross sectional study was conducted among TBI patients with intracranial hematoma undergoing surgical evacuation during a period of 16th June 2021 to 17th December 2022. Plasma INR and aPTT levels were analysed at Mulago hospital clinical hematological laboratory unit on admission to the Accident and emergency. Demographic and hematological data were captured using the Research Electronic Data Capture (Redcap) system. Patients with high aPTT and INR on admission were monitored for hematoma enlargement complications until surgical evacuation decision making. The independent outcomes were the INR and an aPTT value. The dependent outcomes were hematomas enlargement of over 33% evidence by two CT scans (baseline and follow up) and demographic characteristic. Univariable and multivariable logistic regression analysis were used to identify variables associated with hematoma enlargement. Results Intracranial hematomas were observed in all 324 patients and of these 59.3% had EIH. Patients with EIH had a statistically different mean age from those without EIH (42.3 ± 17.9 vs. 30.5 ± 14.0 years, p < 0.001). About 79.7% were males in EIH group versus 81.7% in no EIH group. The main cause of EIH was road traffic crushes involving motorcycle riders (60.5%). Raised INR and a PTT were observed in 58.9% and 59.6% among patients respectively. At multivariate, for every unit increased in plasma INR value, risk of hematoma expansion increased by 3.76 times [β = 3.76, 95% CI: 0.936 to 0.981]. Similarly, every unit increased in plasma aPTT value, risk of hematoma expansion increased by 5.82 times [β = 5.82, 95% CI: 0.909 to 0.954]. Conclusion EIH, elevated INR and aPTT are common with a prevalence of 59.3%,58.9% and 59.6% among TBI patients respectively. Patients with raised INR, aPTT have 3.76- and 5.82-times higher risk of developing a EIH respectively when compared to controls. These findings imply routine plasma INR and aPTT levels monitoring and could form the basis for establishing a hematological control protocol for such patients in remote settings.
Background: During its first wave of COVID-19 infection in sub-Saharan Africa, there was insufficient understanding of the pandemic among front-line health care professionals that has led to a misidentification, and mistreatment of affected patients, with a potential risk of contracting and spreading the disease. This study was carried out to determine the Knowledge, attitude, and practices (KAP) of front-line health workers (HWs) towards COVID-19 in Africa and their related factors.Methods: This was a multi-centers online cross-sectional study conducted over a 3-months study-period using a google survey link among front lines HWs involved in the COVID-19 response in 26 African countries. Chi-square test & logistic regression were used in the bivariate and multivariate analysis respectively to assess determinants of KAP. Statistical analysis was done using STATA version 16; all tests were two-sided with 95% confidence interval. Results: Five hundred and seventeen (517, 96.3%) consented to participate in this study from 26 African countries; 289 (55.9%) were male and 228 (44.1%) female. Overall, most of HWs, 379 (73.3%) showed poor knowledge about COVID-19 infection and preventive measures. In contrast, majority of them showed good attitude (89%) and practice (90.3%) towards prevention of COVID-19 infections. Knowledge varied among countries; Uganda had the greatest number of HWs with good knowledge. (OR = 28.09, p <0.0001) followed by Ghana (OR=10.92, p=0.001) and DRC (OR: 4.59, p=0.015). The cadre of HWs also influenced knowledge; doctors were the most knowledgeable as compared to other cadres (OR: 3.4, p= 0.005). Additionally, knowledge increased with increasing HWs’ education level (p=0.011).Attitude and practice were both influenced by HWs country of workplace (p=0.05 & p< 0.0001 respectively) and their cadre (p = 0.025 & p < 0.0001 respectively).Conclusions: Majority of the front-line HWs in the African region had an overall good attitude and practice towards COVID-19 infection and practice measures despite relatively poor Knowledge. The KAP is influenced by HWs country of workplace, their cadre and level of education.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.