Early outcome of postoperative pyrexia following major surgery in Mulago Hospital

Background: This study was undertaken with the main objectives of determining the incidence, the associated factors and the early outcome of postoperative pyrexia and documenting the use of perioperative antibiotic therapy in the elective major surgical patient.Methods: This was a 5months prospective study carried out in the surgical wards of Mulago Hospital in Uganda. The study variables including socio-demographic characteristics, type of surgery, surgical approach and procedure, operative diagnosis, use of antibiotics, operative wound, and usage of drains, blood transfusion and preoperative stay were recorded in 168 patients undergoing elective major surgery. Six hourly body temperatures were recorded and all patients were daily reviewed for infections and malaria. Laboratory investigations were clinically oriented.Results: Postoperative pyrexia occurred in 13.7% of patients undergoing elective major surgery. Malignancy, intestinal resection and anastomosis, urinary catheterization, nasogastric tube, intraoperative blood transfusion and prophylactic antibiotics were significantly associated with postoperative pyrexia (p<0.05). Surgical site infection, chest infection, urinary tract infection and malaria were the major causes of postoperative pyrexia. Prophylactic antibiotics were used in 16.7% of the patients whereas liberal postoperative antibiotic prescription was done in 93.5% for an average duration of 5 days. Postoperative pyrexia significantly increased the length of hospital stay (p=0.016).Conclusion: Infections and malaria are important causes of postoperative pyrexia. All pyrexial patients should be investigated for malaria. There is a need for a policy regarding the use of perioperative antibiotics in Mulago hospital

High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>There is limited data on Methicillin resistant <it>Staphylococcus aureus </it>(MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA.</p> <p>Results</p> <p>One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of <it>Staphylococcus aureus</it>. Forty one <it>S. aureus </it>isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and <it>mecA/femA/nuc</it>-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and <it>ica </it>genes. One isolate positive for all determinants possessed the <it>bhp </it>homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCC<it>mec </it>type I was the most common at 54% prevalence (22/41), followed by <it>SCCmec </it>type V (15%, 6/41) and <it>SCCmec </it>type IV (7%, 3/41). <it>SCCmec </it>types II and III were not detected and 10 isolates (24%) were non-typeable.</p> <p>Conclusions</p> <p>Hyper-virulent methicillin resistant <it>Staphylococcus aureus </it>is prevalent in the burns unit of Mulago hospital.</p

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence

Early Outcome of Postoperative Pyrexia Following Major Surgery in Mulago Hospital

Background: This study was undertaken with the main objectives of determining the incidence, the associated factors and the early outcome of postoperative pyrexia and documenting the use of perioperative antibiotic therapy in the elective major surgical patient. Methods: This was a 5months prospective study carried out in the surgical wards of Mulago Hospital in Uganda. The study variables including socio-demographic characteristics, type of surgery, surgical approach and procedure, operative diagnosis, use of antibiotics, operative wound, and usage of drains, blood transfusion and preoperative stay were recorded in 168 patients undergoing elective major surgery. Six hourly body temperatures were recorded and all patients were daily reviewed for infections and malaria. Laboratory investigations were clinically oriented. Results: Postoperative pyrexia occurred in 13.7% of patients undergoing elective major surgery. Malignancy, intestinal resection and anastomosis, urinary catheterization, nasogastric tube, intraoperative blood transfusion and prophylactic antibiotics were significantly associated with postoperative pyrexia (p<0.05). Surgical site infection, chest infection, urinary tract infection and malaria were the major causes of postoperative pyrexia. Prophylactic antibiotics were used in 16.7% of the patients whereas liberal postoperative antibiotic prescription was done in 93.5% for an average duration of 5 days. Postoperative pyrexia significantly increased the length of hospital stay (p=0.016). Conclusion: Infections and malaria are important causes of postoperative pyrexia. All pyrexial patients should be investigated for malaria. There is a need for a policy regarding the use of perioperative antibiotics in Mulago hospital

Combining ability and heritability analysis of sweetpotato weevil resistance, root yield, and dry matter content in sweetpotato

Efficient breeding and selection of superior genotypes requires a comprehensive understanding of the genetics of traits. This study was aimed at establishing the general combining ability (GCA), specific combining ability (SCA), and heritability of sweetpotato weevil (Cylas spp.) resistance, storage root yield, and dry matter content in a sweetpotato multi-parental breeding population. A population of 1,896 F1 clones obtained from an 8 × 8 North Carolina II design cross was evaluated with its parents in the field at two sweetpotato weevil hotspots in Uganda, using an augmented row-column design. Clone roots were further evaluated in three rounds of a no-choice feeding laboratory bioassay. Significant GCA effects for parents and SCA effects for families were observed for most traits and all variance components were highly significant (p ≤ 0.001). Narrow-sense heritability estimates for weevil severity, storage root yield, and dry matter content were 0.35, 0.36, and 0.45, respectively. Parental genotypes with superior GCA for weevil resistance included “Mugande,” NASPOT 5, “Dimbuka-bukulula,” and “Wagabolige.” On the other hand, families that displayed the highest levels of resistance to weevils included “Wagabolige” × NASPOT 10 O, NASPOT 5 × “Dimbuka-bukulula,” “Mugande” × “Dimbuka-bukulula,” and NASPOT 11 × NASPOT 7. The moderate levels of narrow-sense heritability observed for the traits, coupled with the significant GCA and SCA effects, suggest that there is potential for their improvement through conventional breeding via hybridization and progeny selection and advancement. Although selection for weevil resistance may, to some extent, be challenging for breeders, efforts could be boosted through applying genomics-assisted breeding. Superior parents and families identified through this study could be deployed in further research involving the genetic improvement of these traits