Browsing by Author "Luggya, Tonny Stone"

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    Aetiology and Presentation of Intestinal Obstruction among Patients Presenting to a Tertiary Hospital in Uganda
    (Int J Crit Care Emerg Med, 2016) Nakanwagi, Arlene Muzira; Kijjambu, Stephen C.; Ongom, Peter; Luggya, Tonny Stone
    Intestinal Obstruction is the impairment of normal flow of intestinal contents from mouth to anal canal with aetiology that varies depending on various factors. Understanding aetiology of a country’s surgical services has proven to aid better planning for its emergency surgical conditions. Mulago, which is Uganda’s National Referral Hospital, is resource constrained with a surgical burden of 33% due to acute abdomen with Intestinal Obstruction. This study aimed to determine the current presentation pattern and etiological factors of Intestinal Obstruction at Mulago. Ethical approval was got, from Makerere University School of Medicine IRB, to carry out a prospective observational study among surgical patients admitted to Mulago Hospital’s surgical wards and units. All patients admitted to the hospital for the study period that fitted the inclusion criteria, with suspected partial or complete Intestinal Obstruction or those with confirmed diagnosis intraoperatively were consented and enrolled. Results: We recruited 110 with 79 (71.8%) males and 31 (28.2%) females. Paediatric patients of 0-12 years were 45 (41.0%) and 65 (59%) were adults above 13 years. We had 50% that presented after 72 hrs of symptoms, 24.6% of these were initially managed in a health centre and only 7.3% of the participants presented within 24 hours. The commonest symptoms that presented were colicky abdominal pain, vomiting, abdominal distension and relative constipation. Hernias were the commonest cause of Intestinal Obstruction in adults followed by gut volvulus then adhesions and tumours while in the paediatric group had intussusceptions as the most common aetiological factor followed by Anorectal malformations and then congenital atresia plus stenosis as third commonest cause of in children respectively. Hernias followed by intestinal volvulus were the commonest adult aetiology while intussusceptions followed by Anal Rectal Malformations were the commonest paediatric aetiology of intestinal obstruction. In Mulago hospital with colicky abdominal pain, abdominal distension and vomiting as the commonest presenting symptoms with males the predominantly affected sex.
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    Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial
    (Anesthesiology Research and Practice, 2017) Mwase, Richard; Luggya, Tonny Stone; Kasumba, John Mark; Wanzira, Humphrey; Kintu, Andrew; Obua, Daniel
    Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.” Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178.