Background Traumatic brain injury (TBI) is a major cause of long‐term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource‐poor setting. Methods Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary's Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In‐hospital management and mortality were recorded. Severe head injury was defined as a Glasgow Coma Scale score below 9. Results A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4·9 : 1). Some 30·9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8·8 per cent. Treatment was mainly conservative in 94·8 per cent of patients; three patients (1·5 per cent) had burr‐holes, four (2·1 per cent) had a craniotomy, and three (1·5 per cent) had skull fracture elevation. The mortality rate was 33·0 per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr‐hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0·012), referral status (P = 0·001), respiratory distress (P = 0·040), severe head injury (P = 0·011) and pupil reactivity (P = 0·011). Conclusion TBI in a resource‐poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes.

We studied our 30-day postoperative outcomes in patients with non-traumatic gastroduodenal perforation (NTGDP) in Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a one-year prospective study of patients who underwent exploratory laparotomy for suspected NTGDP between June 2016 and July 2017. Twenty-nine patients had NTGDP, the male-to-female ratio was 3:1 and median age was 60 years (range = 13–80 years). Most (83%) patients were negative for Helicobacter pylori on histology. One patient had a gastric adenocarcinoma. A total of 26 (90%) patients had Graham's omentopexy performed. The 30-day mortality rate was 34%. Pyrexia at hospital admission, pre-surgical delay (> 72 h), preoperative shock and peritoneal contamination, were associated with higher mortality rates with preoperative shock being an independent predictor of mortality. H. pylori-negative NTGDP presents a unique challenge in our setting, affecting mainly middle-aged and elderly patients. One-third of our patients did not survive one month.

Background Esophageal candidiasis (OC) is a common AIDS-defining opportunistic infection. Antiretroviral therapy (ART) reduces the occurrence of OC and other opportunistic infections among persons living with HIV (PLHIV). We sought to determine and compare the prevalence of OC in the ART and pre-ART era among PLHIV in sub-Saharan Africa (SSA). Methods We searched PubMed, Embase, Web of Science, and the African Journals Online databases to select studies in English and French reporting the prevalence of HIV-associated OC in SSA from January 1980 to June 2020. Reviews, single-case reports, and case series reporting < 10 patients were excluded. A random-effect cumulative meta-analysis was performed using STATA 16.0, and trend analysis performed using GraphPad Prism 8.0. Results Thirteen eligible studies from 9 SSA countries including a total of 113,272 patients were qualitatively synthesized, and 9 studies were included in the meta-analysis. Overall pooled prevalence of HIV-associated OC was 12% (95% confidence interval (CI): 8 to 15%, I2 = 98.61%, p <. 001). The prevalence was higher in the pre-ART era compared to the ART era, but not to statistical significance (34.1% vs. 8.7%, p = 0.095). In those diagnosed by endoscopy, the prevalence was higher compared to patients diagnosed by non-endoscopic approaches, but not to statistical significance (35.1% vs. 8.4%, p = .071). The prevalence of OC significantly decreased over the study period (24 to 16%, p < .025). Conclusion The prevalence of OC among PLHIV in the ART era in SSA is decreasing. However, OC remains a common problem. Active endoscopic surveillance of symptomatic patients and further empirical studies into the microbiology, optimal antifungal treatment, and impact of OC on quality of life of PLHIV in SSA are recommended.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Introduction: Prostate cancer is the second commonest cancer in men worldwide. At present, every patient with lower urinary tract symptoms (LUTS) in St. Mary’s Hospital Lacor is undergoing prostate biopsy regardless of the prostate specific antigen (PSA) level. We sought to determine the association between PSA and malignant prostate histology. Methods: This was a retrospective study. Data on age, PSA, prostate volume and prostate histology reported between Jan 2012 and Dec 2019 were retrieved from St. Mary’s Hospital Lacor archive and analyzed using STATA SE/13.0. Results: Records of 97 patients with LUTS was analyzed. The median (range) age of the patients was 71 (43-100) years. Median (range) of prostate volume was 91.8 (8.0-360.0) cc. Overall, PSA ranged from 0.21 to 399.2 ng/ml. Prostate histology showed 3.1% acinar adenocarcinoma, 24.7% adenocarcinoma and 72.2% benign prostatic hyperplasia. The median PSA amongst pa- tients with malignant and non-malignant prostates were 15.8 ng/ml and 6.07 ng/ml respectively. Serum PSA level was signifi- cantly higher in patients with malignant prostate histology (Difference of mean= 9.7; p=0.001). Conclusion: Patients with LUTS and PSA levels of 15ng/ml or more were more likely to have malignant prostate histology. Keywords: Prostate specific antigen; Prostate cancer.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Jejunoileal atresia is a common cause of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting where surgical care is lacking. Herein, a 4-day-old presented with features of acute abdomen and septicaemia, managed with ileostomy diversion and recovered uneventfully. Back ground Neonatal surgical care and neonatal intensive care is lacking in Uganda while jejunoileal atresia and stenosis are still the most common causes of neonatal intestinal obstruction with high mortality and morbidity in a low resource setting. Herein, we presented a 4-day-old neonate who presented to the emergency department as a referral from distant peripheral hospital with features of acute abdomen and septicaemia. He was resuscitated and an ileostomy diversion created. He recovered uneventfully from the hospital and discharged. However, he passed on upon readmission six weeks later from severe acute malnutrition. Conclusion A high index of suspicious on concomitant intestinal perforation in a neonate presenting with intestinal obstruction and delayed access to surgical care while approaches such as intestinal diversion should be sought carefully to mitigate serious consequences of anastomotic leak from primary bowel repair.

Background: Traumatic brain injury (TBI) is a common cause of death in the Intensive care units and emergency departments with an estimated annual global mortality of 1.5 million people as a result of severe TBI. The prevalence of TBI varies according to regions. Despite this, there is limited data on the outcomes of patients following severe traumatic brain injury in southwestern Uganda. Herein, we studied the prevalence and outcome of severe traumatic brain injury at Mbarara Regional Referral Hospital (MRRH) at discharge.Methods: A retrospective chart review of all TBI over six months (August 2016 - February 2017). The primary outcome was the Glasgow Outcome Scale (GOS) score at discharge. A favorable outcome was either good recovery or moderate disability while unfavorable outcome was severe disability, persistent vegetative state or death. Bivariate and multivariate logistic regression analyses were used to determine the factors associated with GOS score at discharge. Data were analyzed using STATA v13.0.Results: A total of 196 hospital records of TBI patients were reviewed, 80 (40.8%) patients had severe TBI, with the average length of hospital stay at 4.3 ± 2.9 days. The mean patients' age was 35 ± 14 years with the most affected age group being 18 - 34 years (58.8%). The GOS score at discharge were; death (42.5%), persistent vegetative state (0%), severe disability (1.3%), moderate disability (3.8%) and good recovery (52.5%). Pupil size and response had a dose-response relationship with unfavorable outcome when both pupils were dilated and non-reactive to light and had a higher odd ratio (OR=6.05) and strongly associated with unfavorable outcome (p=0.011). However, surgery and seizure prophylaxis were significantly associated with favorable outcome (p=0.033), (p=0.016) and a lesser odd ratio (OR=0.29),(OR=0.31) of having unfavorable outcome respectively. Conclusion: Mbarara regional referral hospital, the prevalence of STBI is still high. Both surgery and seizure prophylaxis were associated with favorable outcome at discharge. However, unfavorable outcome was mainly seen amongst patients who develop a complication.