Introduction: Intestinal stomas remain important life-saving surgical options in a wide range of gastrointestinal pathologies globally. Living with a stoma has potential to impair the patient’s quality of life, often with associated negative psychological effects. Objective: To evaluate the quality of life among intestinal stoma patients under Mulago National Referral Hospital (MNRH), with emphasis on psychological effects and effects on family-social interactions. Methodology: A cross-sectional study carried out at surgical outpatient clinics of MNRH between January and June 2018. Data was collected using Stoma-QOL questionnaire, PHQ-9 and GAD-7 from 51 participants who had lived with intestinal stomas for at least a month. Results: Of the 51 participants, male: female ratio was 4:1 and aged 18-84 years (mean age 44.04+18.47 years). 76.5% had colostomy; 23.5% had ileostomy. Majority (88.2%) had temporary stomas. The overall mean Stoma-QOL score was 55.12+ 17.04. Only about a quarter (24%) of participants had Stoma-QOL scores >70 (best). Most patients exhibited negative psy- chological effects (anxiety-100%, concerns about changed body image - 96.1% and depression - 88.4%). Conclusion: Most participants had low levels of stoma-related quality of life, suffered negative psychological effects and exhibited limited social interactions. This calls for efforts to support Stoma patients adapt beter life. Keywords: Stoma; Quality of Life (Stoma-QOL); Psychological effects; Patient Health Questionnaire (PHQ-9); General- ized Anxiety Questionnaire (GAD-7).
Introduction: Health seeking behavior (HSB) is simply an action or inaction of an individual towards their health. For various, at times justifiable reasons, HSB is generally low among healthcare workers in Ugandans. However, this situation could have changed during the covid 19 pandemic era. We set out to assess for determinants of HSB among Healthcare Workers (HWs) in Public and Private Facilities in the Covid-19 hit Kampala capital city of Uganda. Methods: This was a Cross-sectional study with an explanatory-sequential mixed methods design in which we consecutively recruited HWs from the selected health facilities during the study period and met eligibility criteria. A questionnaire was administered using the Open Data Toolkit system and data was later exported into STATA 17/MP for analysis. We summarized it in tables, graphs, mean and SD. Determinants of HSB were assessed using a modified Poison regression method with clustered robust standard errors. Qualitative data from focus group discussions was analyzed using Atlas.ti 9 using the inductive content analysis method. Results: We recruited 579 HWs. The mean and standard deviation of their age was 35±7 years. Majority were females 322 (55.6%). Most of the participants (n=240, 41.5%) worked in government hospitals. Majority 80.5% [95%CI 77.0-83.6] had undergone a medical check-up in the past 12 months. The factors that positively influenced HSB were having a Diploma aPR =0.86 [95%CI: 0.79-0.93], P<0.001, being widowed aPR =1.17 [95%CI: 1.12-1.22], P<0.001, having 10+ years of working experience aPR = 1.07 [95%CI: 1.01-1.13], P= 0.028, having a chronic illness aPR =1.10 [95%CI: 1.03-1.17], P=0.004, having a family doctor aPR=1.12 [95%CI: 1.04-1.21], P=0.004. From the focus group discussions, participants described routine medical check-up as being advantageous, however, sighted barriers to good HSB such as; fear of the unknown, mistrust among colleagues with their confidentiality and busy schedules. The suggested facilitators of good HSB included; good hospital policies, waiver money for medical checkups and treatment, increase salaries, having CMEs, and increased awareness about good HSB practices. Conclusions: Although not the desirable, commendable HSB was exhibited by HWs during the Covid-19 era a norm that must be replicated years after.
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.
Abdominal cocoon syndrome (ACS) is a rare cause of small bowel obstruction characterized by partial or complete encasement of small bowel loops in a thick fibro-collagenous sac. It poses diagnostic difficulties due to the non-specific nature of its presentation and thus in most cases, diagnosed incidentally at laparotomy.The researchers present a case of a 27-year old female Ugandan who presented to a rural hospital in Northern Uganda with complaints of central abdominal pain, failure to pass stool and bilious vomiting for three days. She also had feelings of a peri-umbilical mass. She had several episodes of related obstructive symptoms that would be self-limiting for a year. She had unremarkable past surgical, past medical and past gynecological history. Laboratory investigations were unremarkable.Preoperative diagnosis of small bowel intussusception was made basing on examination and ultrasonography report and the patient was managed operatively. At laparotomy, almost all the small bowel loops were found encased in a thick, whitish, fibrous membrane. There was also marked inter-loop adhesions. The membranous sac was incised and completely removed using both sharp and blunt dissection. Inter-loop adhesions were released solely by blunt dissection.The patient recovered postoperatively and was discharged on the seventh postoperative day.
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