Feasibility and acceptability of undertaking postmortem studies for tuberculosis medical research in a low income country

IntroductionIf we are to break new ground in difficult-to-treat or difficult-to-vaccinate diseases (such as HIV, malaria, or tuberculosis), we must have a better understanding of the immune system at the site of infection in humans. For tuberculosis (TB), the initial site of infection is the lungs, but obtaining lung tissues from subjects suffering from TB has been limited to bronchoalveolar lavage (BAL) or sputum sampling, or surgical resection of diseased lung tissue.MethodsWe examined the feasibility of undertaking a postmortem study for human tuberculosis research at Mulago National Referral Hospital in Kampala, Uganda.ResultsPostmortem studies give us an opportunity to compare TB-involved and -uninvolved sites, for both diseased and non-diseased individuals. We report good acceptability of the next-of-kin to consent for their relative’s tissue to be used for medical research; that postmortem and tissue processing can be undertaken within 8 hours following death; and that immune cells remain viable and functional up to 14 hours after death.DiscussionPostmortem procedures remain a valuable and essential tool both to establish cause of death, and to advance our medical and scientific understanding of infectious diseases

Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design

Abstract Background Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). Methods A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of &lt; 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Results Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS &lt; 3, QoLIBRI &lt; 50, SDH, contusion, and EIH. Conclusion EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS &lt; 3, QoLIBRI &lt; 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH. </jats:sec

The complications encountered.

SSI: Surgical site infection; DOT: Death on table.</p

Map of the region with location of the different hospitals in DRC and Uganda performed using QGIS software with RGC (Referentiel Geographique Commun) for shapefile of DRC and North-Kivu (https://www.rgc.cd/).

Map of the region with location of the different hospitals in DRC and Uganda performed using QGIS software with RGC (Referentiel Geographique Commun) for shapefile of DRC and North-Kivu (https://www.rgc.cd/).</p

Predictors of a negative coping mechanism (blaming self or others, alcohol use, self-destruction, disassociation) following occurrence of a complication.

Predictors of a negative coping mechanism (blaming self or others, alcohol use, self-destruction, disassociation) following occurrence of a complication.</p

Coping mechanisms used by the participants following a complication.

Coping mechanisms used by the participants following a complication.</p

Predictors of a negative coping mechanism (blaming self or others, alcohol, self-destruction, disassociation).

Predictors of a negative coping mechanism (blaming self or others, alcohol, self-destruction, disassociation).</p

Forms of emotional impact seen following a complication.

Forms of emotional impact seen following a complication.</p

Baseline characteristics of study participants.

We aimed to assess the psychosocial impact from postoperative complications on the surgical workforce and the coping mechanisms they use following these complications in Uganda and Eastern Democratic Republic of the Congo (DRC). This was a cross-sectional multi-center study conducted from first February 2022 to 31st March 2022 in the preselected main teaching hospitals of Uganda and Eastern DRC. We surveyed the surgical workforce (practicing surgeons, Obstetrician-Gynecologists, and residents in surgery/ Obstetrics-Gynecology) who had experienced postoperative complications in their career. Data was analysed using SPSS version 23. One hundred ninety-eight participants responded to the questionnaire. Worry about patient and reputation were the commonest psychological impacts in 54.0% and 45.5% of the participants respectively. Majority of the participants (55.1%) used positive coping mechanisms with a positive impact on their practice (94.4%). Being a female doctor (AOR = 2.637, CI 1.065–6.533, P = 0.036), worrying about reputation (AOR = 3.057, CI = 1.573–5.939, P = 0.001) and guilt after a complication (AOR = 4.417, CI = 2.253–8.659, P = </div

Impact on surgical practice of participants following the complications.

Impact on surgical practice of participants following the complications.</p