Traumatic Asphyxia During Stadium Stampede

A CAJM article on asphyxia during a mass stampede.On the 9 July 2000 there was a stampede at the National Sports Stadium in Harare after police threw CS tear-gas into the crowd on the terraces to quell disturbances during a soccer match. This resulted in 13 deaths, four admissions to intensive care and 35 others injured. Since then, several similar incidents have occurred across Africa with more or less numbers of casualties. We describe below the clinical cases and the post mortem findings

Separation of Conjoined Twins in Harare, Zimbabwe: Case Report.

Conjoined twins are rare, and those surviving beyond the first 24hrs occur about 1:200,000 pregnancies. There are often conflicting interests in their management. Medically, few are separable. The families may not want separation for emotional, religious and ethical reasons. Technically the surgery is often difficult and resource intensive. The occurrence of conjoined twins in a resource poor setting presents all these challenges. We present a case of successful elective separation of conjoined twins, in a resource poor setting.Key words: Conjoined, twins, separatio

Comparison of haemodynamic effects of a bolus of five units of oxytocin versus a bolus of ten units of oxytocin on parturients undergoing caesarean section at Parirenyatwa and Harare hospitals, Zimbabwe

Objectives: This study was done to compare the haemodynamic effects of an intravenous bolus of 5 IU oxytocin versus a bolus of 10 IU.Study Design: A prospective randomised clinical trial.Setting: The study was conducted at Harare Central Hospital Maternity Unit and Mbuya Nehanda Maternity hospitalStudy Subjects: The study was conducted in 86 ASA 1 and 2 parturients undergoing spinal anaesthesia for elective and emergency caesarean sectionMethods: The 86 patients were randomized to receive either five IU or ten IU of oxytocin post-delivery. Noninvasive monitoring of Heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) was done. Blood loss was also measured.Results: There was a statistically significant greater increase in mean Heart rate in patients who received 10 IU than in those who received 5 IU of oxytocin (p=0.028). There was a larger decrease in Mean Arterial Pressure, Diastolic blood pressure and Systolic blood pressure in patients who received 10 IU of oxytocin than in patients who received 5 IU of oxytocin (p<0.0001). There was no difference in blood loss between the two groups.Conclusions: During caesarean section, a bolus of 5 IU oxytocin results in less haemodynamic change than a bolus of 10 IU of oxytocin with no difference in the blood loss

Metabolic effects of Carbon Dioxide (CO2) insufflation during laparoscopic surgery: changes in pH, arterial partial Pressure of Carbon Dioxide (PaCo2) and End Tidal Carbon Dioxide (EtCO2)

Background: Acid base alterations occur during laparoscopy with carbon dioxide insufflation. The purpose of this study was to investigate the effects of low tidal volume ventilation on acid base status during pneumoperitonium.Materials and Methods: 30 patients undergoing laparoscopic surgery under General Anaesthesia were ventilated with tidal volume of 6 ml/kg and respiratory rate of 12 breaths/minute. Arterial blood gas analysis was done before, during and after C02 pneumoperitoneum. Arterial haemoglobin oxygen saturation by pulse oximetry (SPO2) and EtC02 were monitored continuously throughout the laparoscopy. Respiratory adjustments were done for EtCO2 levels above 60mmHg or SPO2 below 92% or adverse haemodynamic changes.Results: low tidal volume ventilation during pneumoperitoneum resulted in a significant elevation in PaCO2 (p<0.001) and a fall of pH (p <0.001), ion bicarbonate (HCO3-) (p = 0.011), and base excess (ABE) (p <0.001). A correlation was found between the EtCO2 and PaCO2 during pneumoperitoneum. Oxygenation was well maintained during pneumoperitoneum. No ventilatory adjustments were instituted on any of the patients as they maintained EtCO2 below 60mmHg throughout pneumoperitoneum.Conclusion: Ventilation with low tidal volume during pneumoperitoneum causes a mixed respiratory and metabolic acidosis. EtCO2 is still a good non-invasive monitor for estimation of PaCO2 during low tidal volume ventilation during pneumoperitoneum

Optimization of wood ash-catalysed biodiesel production from used vegetable oil using response surface methodology

9th World Congress of Chemical Engineerin

Severe malaria in Parirenyatwa Hospital, Harare Intensive Care Unit: a case record review of 16 cases

Background: Zimbabwe has reported a decrease in malaria admissions and mortality rates by 64% and 71% respectively between 2003 and 2012, suggesting the country is on track to achieve a decrease in admission rates by 50-75% and mortality rates by >75% by 2015. The aim of this study is to review the Intensive Care Unit (ICU) outcomes of the malaria patients admitted into Parirenyatwa Group of Hospitals (PGHs) adult  ICU and to determine whether the Multiple Organ Dysfunction Score can be applied to a small set of patients with severe malaria in our unit.Materials and Methods: A retrospective case record review of patients admitted in ICU with a diagnosis of malaria at PGH general adult ICU. Demographic data, clinical data, laboratory data and data on interventions in ICU were collected. Multiple Organ Dysfunction Score (MODS), Malaria Prediction Score (MPS) and Malaria Score for Adults (MSA) were applied for all patients.Results: Sixteen (16) malaria patients were included in the study and all were adults with an age range of 18-68 and 10 (62.5%) were female. Parasitaemia on admission was quantified in 8/16 (50%) patients were 2 patients had parasitaemia greater than 5% and 6 had parasitaemia less than 5%. The complications included unarousable coma 12 (75%), persistent seizures 6 (37.5%), circulation collapse 3 (18.8%), Moderate to severe ARDS 4 (25%), renal impairment 7 (44%), severe metabolic acidosis 8 (50%), severe anaemia 8 (50%), severe thrombocytopaenia 4 (25%), hyperbilirubinaemia 9 (56%) and hypoglycaemia 2 (12.5%). The case fatality rate was 50%. Death was associated with a shorter duration of ICU stay and higher MODS scores.Conclusion: Although antimalarial therapies are the mainstay of malaria treatment, ICU admission and interventions remain pivotal in reducing morbidity and mortality in severe malaria. The MODS score is a good predictor of mortality in a small number of malaria patients; however specific scores should be studied

Determining the Minimum Dataset for Surgical Patients in Africa: A Delphi Study.

BACKGROUND: It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised perioperative dataset for use in a registry. METHODS: A Delphi method was followed to achieve consensus on the data points to include in a minimum perioperative dataset. The study consisted of two electronic surveys, followed by an online discussion and a final electronic survey (four Rounds). RESULTS: Forty-one members of the African Perioperative Research Group participated in the process. Forty data points were deemed important and feasible to include in a minimum dataset for electronic capturing during the perioperative workflow by clinicians. A smaller dataset consisting of eight variables to define risk-adjusted perioperative mortality rate was also described. CONCLUSIONS: The minimum perioperative dataset can be used in a collaborative effort to establish a resource accessible to African clinicians in improving quality of care

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study

CITATION: Bishop, D. et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. The Lancet Global Health, 7(2):e513-e522. doi:10.1016/S2214-109X(19)30036-1The original publication is available at https://www.thelancet.com/journals/langlo/issue/vol7no2/PIIS2214-109X(19)X0002-9Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30036-1/fulltextPublisher’s versio