Browsing by Author "Makumbi, Timothy"

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    Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in‑hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study
    (BMC surgery, 2022) Iranya, Richard Newton; Mbiine, Ronald; Semulimi, Andrew Weil; Nasige, Joan; Makumbi, Timothy; Galukande, Moses
    The majority of the prognostic scoring tools for peritonitis are impractical in low resource settings because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA) score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis. Method: This was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital, or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals. Results: We evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a significantly better discriminative ability (AUC = 0.893, 95% CI 0.801–0.986) than the qSOFA score (AUC = 0.770, 95% CI 0.620–0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2), were 58.8% and 98.3% respectively. Conclusions: The in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic tool for peritonitis cases in the emergency department.
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    Pattern of sub-clinical dysthyroidism in a postthyroidectomy cohort: Implications for supplementary treatment
    (East and Central African Journal of Surgery, 2018) Luwaga, Ronald Kint; Makumbi, Timothy; Kilyewala, Cathy; Fualal, Jane O.
    Defective thyroid functioning is referred to as dysthyroidism. Despite incomplete thyroidectomy or thyroxine supplementation, post-thyroidectomy patients may still experience dysthyroidism. Many times, this may be sub - clinical. This study aimed to assess the prevalence and pattern of sub-clinical dysthyroidism following thyroid surgery.In this prospective cohort study, 40 patients were consecutively recruited following conventional thyroidectomy and followed up to 12months. All patients were euthyroid at surgery. At 12 months serum TSH, T4 and T3 levels were measured and the patients clinically assessed. The prevalence and pattern of dysthyroidism was analysed statistically against the patient demographics, clinical and peri-operative variables for significance, using stata version 13. The confidence interval was at 95% and the statistical significance at a p-value of <0.05. The mean age was 44.3 years (M:F= 1: 12.3). 20% of the patients had medical comorbidities. The types of surgery performed were sub-total thyroidectomy (55%), near total thyroidectomy (25%) and total thyroidectomy (20%). The prevalence of postoperative dysthyroidism was 52.5%. 22.7% of patients who underwent sub-total thyroidectomy had dysthyroidism. Most patients (90%) who were on thyroxine supplement (following total or near total thyroidectomy) still developed dysthyroidism (P= 0.017). The type of resection done had the greatest significance (P= 0.000). Other factors associated with dysthyroidism albeit non-significantly were history of pre-operative hyperthyroidism, middle age (40 - 60 years), and female gender. The prevalence of dysthyroidism in this cohort was high which may reflect the broader picture among post - thyroidectomy patients in this setting. Regular biochemical testing in post-thyroidectomy patients is important to identify and correct dysthyroidism early. This requires frequent follow-up and accurate dose adjustment, based on objective assessments like weight or body mass index.
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    Postoperative Sepsis Among HIV-Positive Patients with Acute Abdomen at Tertiary Hospital in Sub-Saharan Africa: a Prospective Study
    (SN Comprehensive Clinical Medicine, 2019-06-15) Awale, Mohamed Abdullahi; Makumbi, Timothy; Rukundo, Gideon; Kisuze, Geoffrey; Semakula, Daniel; Galukande, Moses
    The incidence of HIV in Uganda as reported by UNAIDS (2012) was increased from 6.7% in 2004 to 7.6% to 2012. The main threat to HIV-infected patients following surgery is the development of sepsis. Inadequacy of surgical supplies and human resources further hastens and complicates the postoperative sepsis in HIV patients. The objective of the study was to determine incidence and risk factors associated with postoperative sepsis, among HIV seropositive with acute abdomen. A prospective study ran for a period of 11 months from October 2015 to April 2016 in Mulago Hospital in Kampala. Eligible patients were recruited and included. Study variables included postoperative wound sepsis, type of surgery, and CD4 counts. Thirty-eight data were collected using a questionnaire then entered in the Epidata software 3.1 and analyzed by Stata software version. Sixty-two patients were recruited; of these, 42 were male, 37 were HIV-negative and 25 were HIV-positive. The proportion of patients with postoperative sepsis in the HIV-positive group was 7 (28%) and in the HIV-negative group was 8 (21.6%). The number of patients discharged in HIV-positive group was 24 (96%) and in HIV-negative group was 35 (94.6%). Among the HIV-positive group was 1 out of 25 (4) % and HIV-negative was 2 out of 37 (5.4%). The overall postoperative sepsis incidence rate was 3 per 100 person days for under observation (95% CI 0.02–0.1), and the incidence rate ratio of HIV-positive patients and HIV-negative was 1.04 (95% CI 0.32–3.3; P = 0.47. The limited health resource was associated with developing postoperative sepsis. There was a higher risk of positive operative sepsis among HIV-positive compared to HIV-negative patients undergoing surgery for acute abdominal conditions.