Browsing by Author "Kintu, Andrew"

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    Effect of low-dose ketamine on post-operative serum IL-6 production among elective surgical patients: a randomized clinical trial
    (African Health Sciences, 2017) Luggya, Tonny S.; Roche, Tony; Ssemogerere, Lameck; Kintu, Andrew; Kasumba, John M.; Kwizera, Arthur; Tindimwebwa, Jose V. B.
    Surgery and Anesthesia cause an excessive pro-inflammatory response. Mulago Hospital is faced with staff shortage making post-operative pain management difficult.Interleukin-6 (IL-6) drives inflammatory pain, endothelial cell dysfunction and fibrogenesis. Ketamine is cheap and, readily available. We hypothesized that its attenuation of serum IL-6 was a surrogate for clinical benefit. Materials and methods: Institutional Review Board’s approval was sought and RCT was registered at clinical trials.gov (identifier number: NCT01339065). Consenting patients were randomized to receive pre-incision intravenous ketamine - 0.5mg/kg or 0.9% saline placebo in weighted dosing. Blood samples were collected and laboratory analyzed at baseline, post-operatively in PACU, 24 and 48 hours respectively. Results: We recruited 39 patients of whom 18 were randomized to the ketamine arm and 21 in the placebo arm with follow up at 24 and 48 hours. Serum IL-6 and IL-1β levels were analyzed using ELIZA assay of pre-coated micro wells. Ketamine suppressed serum IL-6 at PACU with reduced increase at 24 hours. There was no reaction in 98% of IL-1β assayed. Conclusion: Low-dose ketamine attenuated early serum IL-6 levels due to surgical response with reduced 24 hour increase, but the difference was not statistically significant and we recommend more studies
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    Effects of propofol versus thiopental on Apgar scores in newborns and peri-operative outcomes of women undergoing emergency cesarean section: a randomized clinical trial
    (BMC anesthesiology, 2015) Tumukunde, Janat; Dlamini, Diana L.; Ocen, Davidson; Kintu, Andrew; Ejoku, Joseph; Kwizera, Arthur
    General and regional anesthesia are the two main techniques used in cesarean section. Regional anesthesia is preferred, but under certain circumstances, such as by patient request and in patients with back deformities, general anesthesia is the only option. Commonly used induction agents include thiopental, ketamine, and propofol, depending on availability and the maternal clinical condition. The objective of this study was to investigate the effects of thiopental and propofol on the neonatal Apgar score and maternal recovery time following emergency cesarean section in order to determine the superior agent for mothers and neonates. Methods: This single-blinded randomized clinical trial included 150 ASA I and II patients block-randomized equally between the two study arms. Pregnant women at term scheduled to undergo cesarean section and their neonates were enrolled. The primary outcomes were the Apgar scores through 10-min postpartum, resuscitation requirement, and admission to the neonatal intensive care unit. The secondary outcome was the maternal recovery times. Results: At 0 min (umbilical cord clamp time), 43 (57.3%) neonates in the propofol group had an Apgar score < 7 compared with 31 (41.3%) neonates in the thiopental group (p = 0.05). The maternal recovery time was shorter in the propofol group than in the thiopental group (25 min vs. 31 min, respectively, p = 0.003). Conclusion: Apgar scores do not differ significantly whether thiopental or propofol is used for anesthetic induction in women undergoing general anesthesia for an emergency cesarean section. Trial registration: Pan-African Clinical Trial Registry (#PACTR201306000536344) http://www.pactr.org/ATMWeb/ appmanager/atm/atmregistry?_nfpb=true&_pageLabel=atm_portal_page_mytrials
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    Feasibility of Simulation-Based Medical Education in a Low-Income Country Challenges and Solutions From a 3-year Pilot Program in Uganda
    (Simulation in Healthcare, 2019) Bulamba, Fred; Sendagire, Cornelius; Kintu, Andrew; Hewitt-Smith, Adam; Musana, Fred; Lilaonitkul, Maytinee; Ayebale, Emmanuel T.; Law, Tyler; Dubowitz, Gerald; Kituuka, Olivia; Lipnick, Michael S.
    Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.
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    Knowledge, Attitudes and use of Labour Analgesia among Women at a Low-income Country Antenatal Clinic
    (BMC anesthesiology, 2015) Nabukenya, Mary T.; Kintu, Andrew; Wabule, Agnes; Muyingo, Mark T.; Kwizera, Arthur
    Childbirth is one of the most painful experiences of a woman’s life. Authorities in the fields of obstetrics and anaesthesia encourage use of labour analgesia. Unlike in high-income countries, pain relief in labour in Africa is not a well established service, especially in the low-income countries like Uganda. Little is known about whether parturients would be amenable to labour analgesia. We sought to determine knowledge, attitudes and use of labour analgesia among women attending the antenatal clinic at Mulago National Referral Hospital.
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    Prevalence, Associated factors and Treatment of Post Spinal Shivering in a Sub-Saharan Tertiary Hospital: a prospective observational study
    (BMC anesthesiology, 2016) Luggya, Tonny Stone; Kabuye, Richard Nicholas; Mijumbi, Cephas; Tindimwebwa, Joseph Bahe; Kintu, Andrew
    Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Due to paucity of data Mulago Hospital’s post spinal shivering burden is unknown yet it causes discomfort and morbidity.