Aerobic Bacterial Causes of Secondary Peritonitis and Their Antibiotic Sensitivity Patterns among HIV Negative Patients with Non-traumatic Small Bowel Perforations in Mbarara Regional Referral Hospital

Back ground: Intra-abdominal infections are commonly encountered in surgical practice and represent a major cause of morbidity and mortality. The most common aetiology is contamination of the peritoneal space by endogenous micro-flora among patients with gastro intestinal perforations. Inappropriate antibiotic therapy of secondary peritonitis may result in poor patient outcomes. The selection of an appropriate empirical antibiotic agent can be challenging amidst limited laboratory infrastructure and the emerging resistance to commonly prescribed antibiotics. This study was aimed at determining the aerobic bacterial causes of secondary peritonitis and their antibiotic sensitivity patterns among HIV negative patients with non-traumatic small bowel perforations in Mbarara Regional Referral Hospital so as to guide initial empirical treatment.Methods: This was a cross-sectional study in which 87 consenting patients with non-traumatic small bowel perforation confirmed at laparotomy, on the emergency ward of Mbarara Regional Referral Hospital were enrolled consecutively from September 2011 to May 2012. HIV testing and peritoneal fluid analysis was done for all patients enrolled into the study.Results: Majority of patients had either Klebsiella spp (37.9%) or Escherichia coli (26.4%) on peritoneal fluid culture, while 12 (13.8%) had no growth at all. Four patients (4.6%) had more than one organism cultured. Most of the organisms were susceptible to Ceftriaxone followed by Ciprofloxacin and Gentamycin. Peritoneal fluid gram stain showed gram negative bacilli in 79.3% of the cases while peritoneal fluid ZN stain did not demonstrate any AAFBs. All patients tested HIV negative.Conclusions: The results indicated that secondary peritonitis among HIV negative patients with non-traumatic small bowel perforation at MRRH was mainly due to Klebsiella spp and E. coli which were mainly sensitive to cephalosporins, quinolones and aminoglycosides.Key words: Aerobic, Bacteria, Secondary, Peritonitis. Antibiotic. Sensitivity, HIV negative, Bowel,Perforatio

Ileosigmoid Knotting in Pregnancy: A case Report Seen in Uganda

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Aetiology and Treatment Outcome of Non-traumatic Small Bowel Perforations at Mbarara Hospital in South-Western Uganda

Background: Non-traumatic small bowel perforation (SBP) is the most common form of gastrointestinal perforation in sub-Saharan Africa. Although SBP is a surgical emergency associated with complications, information regarding its aetiology is scanty in Uganda. This study was aimed at determining the aetiology and document treatment outcomes of non-traumatic small bowel perforations in South-western Uganda. Methods: This was a descriptive case series of 87 consenting patients with non-traumatic SBP confirmed at laparotomy, on the emergency ward of Mbarara University Teaching Hospital. They were enrolled from September 2011 to May 2012. Specimens for blood culture, stool microscopy, HIV testing and tissue biopsies at the site of perforation were collected and analyzed. Patient follow-up was done till discharge. Results: Of the 78 biopsies performed, 66(84.6%) had histological features suggestive of typhoid perforations while 12(15.4%) had features of non-specific inflammation. Salmonella typhi was isolated in 13(15.0%) out of the 87 patients. Isolates were susceptible to Ceftriaxone and Ciprofloxacin. All patients tested HIV negative. Ascaris lumbricoides were seen in two patients. Re-laparotomy was done in four patients with new perforations, two with anastomotic breakdown and two with intra-abdominal abscesses. Wound sepsis was observed in 25(28.7%). Average length of hospital stay was 13 days. Some 10(11.5%) patients died. Conclusions: Most cases of non-traumatic SBP in south western Uganda are associated with Salmonella infection. There is need to enhance laboratory capacity to detect typhoid and preventive measures should be instituted in the general population

Net radiation dynamics: Performance of 20 net radiation models as related to model structure and intricacy in two climates.

We compared daily net radiation (Rn) estimates from 19 methods with the ASCE‐EWRI Rn estimates in two climates: Clay Center, Nebraska (sub‐humid) and Davis, California (semi‐arid) for the calendar year. The performances of all 20 methods, including the ASCE‐EWRI Rn method, were then evaluated against Rn data measured over a non‐stressed maize canopy during two growing seasons in 2005 and 2006 at Clay Center. Methods differ in terms of inputs, structure, and equation intricacy. Most methods differ in estimating the cloudiness factor, emissivity (α), and calculating net longwave radiation (Rnl). All methods use albedo (α) of 0.23 for a reference grass/alfalfa surface. When comparing the performance of all 20 Rn methods with measured Rn, we hypothesized that the α values for grass/alfalfa and non‐stressed maize canopy were similar enough to only cause minor differences in Rn and grass‐ and alfalfa‐reference evapotranspiration (ETo and ETr) estimates. The measured seasonal average α for the maize canopy was 0.19 in both years. Using α = 0.19 instead of α = 0.23 resulted in 6% overestimation of Rn. Using α = 0.19 instead of α = 0.23 for ETo and ETr estimations, the 6% difference in Rn translated to only 4% and 3% differences in ETo and ETr, respectively, supporting the validity of our hypothesis. Most methods had good correlations with the ASCE‐EWRI Rn (r2 \u3e 0.95). The root mean square difference (RMSD) was less than 2 MJ m‐2 d‐1 between 12 methods and the ASCE‐EWRI Rn at Clay Center and between 14 methods and the ASCE‐EWRI Rn at Davis. The performance of some methods showed variations between the two climates. In general, r2 values were higher for the semi‐arid climate than for the sub‐humid climate. Methods that use dynamic α as a function of mean air temperature performed better in both climates than those that calculate α using actual vapor pressure. The ASCE‐EWRI‐estimated Rn values had one of the best agreements with the measured Rn (r2 = 0.93, RMSD = 1.44 MJ m‐2 d‐1), and estimates were within 7% of the measured Rn. The Rn estimates from six methods, including the ASCE‐EWRI, were not significantly different from measured Rn. Most methods underestimated measured Rn by 6% to 23%. Some of the differences between measured and estimated Rn were attributed to the poor estimation of Rnl. We conducted sensitivity analyses to evaluate the effect of Rnl on Rn, ETo, and ETr. The Rnl effect on Rn was linear and strong, but its effect on ETo and ETr was subsidiary. Results suggest that the Rn data measured over green vegetation (e.g., irrigated maize canopy) can be an alternative Rn data source for ET estimations when measured Rn data over the reference surface are not available. In the absence of measured Rn, another alternative would be using one of the Rn models that we analyzed when all the input variables are not available to solve the ASCE‐EWRI Rn equation. Our results can be used to provide practical information on which method to select based on data availability for reliable estimates of daily Rn in climates similar to Clay Center and Davis