Post-operative complications of stapled versus Ferguson hemorrhoidectomy at Mulago Hospital. A randomized comparative study

Background: Hemorrhoids are a common anorectal condition. New surgical treatments have led to a reappraisal of hemorrhoid disease over the last few decades and despite a range of treatment modalities, the options are limited in their effectiveness and can lead to a number of complications. This study set out to compare post operative complications between stapled haemorrhoidopexy (SH) and Ferguson haemorrhoidectomy (FH) for patients with Grade III and IV in Mulago National Referral and teaching Hospital.Methods: Following ethical approval 48 consenting participants with Grade III/IV hemorrhoids were randomized to either FH or SH under regional anesthesia on 1:1 allocation. Early and short term post-operative complications were analyzed. .Results: We enrolled 24 participants in each arm with equal sex allocation and mean age of 39 years with 100% follow up. There was largely no difference in early and short term complications between FH and SH save for bleeding in the short term follow up which occurred more frequently in the FH group (p-value 0.045). The bleeding was mild and did not require transfusion.Conclusion: There was no major difference in short term complication rates between SH and FH. SH is a safe alternative to FH in Mulago Hospital.Keywords: Ferguson hemorrhoidectomy. Stapled hemorrhoidopexy. Hemorrhoids.PPH, Mulago Hospital, colorectal surger

Clinico-pathological pattern and early post-operative complications of gastro-duodenal perforations at Mulago Hospital Kampala- a prospective cohort study

Background: Gastro-Duodenal Perforations are one of the commonest causes of mortality and morbidity in conditions that require emergency surgery. The main objective of this study was to determine the clinico-pathological pattern and evaluate factors for early post operative complications of Gastro-duodenal perforations in Mulago. Methods: This was a prospective cohort study of patients with gastro-duodenal perforations managed by simple repair between September 2014 and April 2015 in Mulago was studied. Primary/ secondary outcomes were mortality and complications respectively. Data was managed using stata-12 and multivariate analysis using log-binomial regression model. Results: A total of 65 patients were operated for Gastro-duodenal perforations in the study period. 86.2% were male (M: F 6.2:1). Median age was 35 years (range 16- 80 years). 93.9% had gastric perforations. Clinical diagnosis was predicted in 89.3%. H. pyloriwas present in 7.9%. Mortality was 18.5% and complications developed in 58.5%. Age above 35 and presence of   co morbidity predicted mortality (CI 1.22- 21.12, p= 0.009) (CI 1.26- 8.82, p= 0.024) and early post-operative complications (CI 1.03- 2.44, p= 0.031) (CI 1.23- 2.44, p= 0.011) respectively. Conclusion: Gastroduodenal perforations remain a common surgical emergency in Mulago hospital affecting mainly young men below 35 years. Majority are gastric perforations. Mortality and early post-operative complications are high, and increase with age and presence of co morbidity. Keywords: gastro-duodenal perforations, perforated peptic ulcer disease, gastric perforation

Call for emergency action to restore dietary diversity and protect global food systems in times of COVID-19 and beyond: Results from a cross-sectional study in 38 countries

Background: The COVID-19 pandemic has revealed the fragility of the global food system, sending shockwaves across countries\u27 societies and economy. This has presented formidable challenges to sustaining a healthy and resilient lifestyle. The objective of this study is to examine the food consumption patterns and assess diet diversity indicators, primarily focusing on the food consumption score (FCS), among households in 38 countries both before and during the first wave of the COVID-19 pandemic. Methods: A cross-sectional study with 37 207 participants (mean age: 36.70 ± 14.79, with 77 % women) was conducted in 38 countries through an online survey administered between April and June 2020. The study utilized a pre-tested food frequency questionnaire to explore food consumption patterns both before and during the COVID-19 periods. Additionally, the study computed Food Consumption Score (FCS) as a proxy indicator for assessing the dietary diversity of households. Findings: This quantification of global, regional and national dietary diversity across 38 countries showed an increment in the consumption of all food groups but a drop in the intake of vegetables and in the dietary diversity. The household\u27s food consumption scores indicating dietary diversity varied across regions. It decreased in the Middle East and North Africa (MENA) countries, including Lebanon (p \u3c 0.001) and increased in the Gulf Cooperation Council countries including Bahrain (p = 0.003), Egypt (p \u3c 0.001) and United Arab Emirates (p = 0.013). A decline in the household\u27s dietary diversity was observed in Australia (p \u3c 0.001), in South Africa including Uganda (p \u3c 0.001), in Europe including Belgium (p \u3c 0.001), Denmark (p = 0.002), Finland (p \u3c 0.001) and Netherland (p = 0.027) and in South America including Ecuador (p \u3c 0.001), Brazil (p \u3c 0.001), Mexico (p \u3c 0.0001) and Peru (p \u3c 0.001). Middle and older ages [OR = 1.2; 95 % CI = [1.125–1.426] [OR = 2.5; 95 % CI = [1.951–3.064], being a woman [OR = 1.2; 95 % CI = [1.117–1.367], having a high education (p \u3c 0.001), and showing amelioration in food-related behaviors [OR = 1.4; 95 % CI = [1.292–1.709] were all linked to having a higher dietary diversity. Conclusion: The minor to moderate changes in food consumption patterns observed across the 38 countries within relatively short time frames could become lasting, leading to a significant and prolonged reduction in dietary diversity, as demonstrated by our findings

An Evaluation of the COVID-19 Pandemic and Perceived Social Distancing Policies in Relation to Planning, Selecting, and Preparing Healthy Meals: An Observational Study in 38 Countries Worldwide

Objectives: To examine changes in planning, selecting, and preparing healthy foods in relation to personal factors (time, money, stress) and social distancing policies during the COVID-19 crisis. Methods: Using cross-sectional online surveys collected in 38 countries worldwide in April-June 2020 (N = 37,207, Mage 36.7 SD 14.8, 77% women), we compared changes in food literacy behaviors to changes in personal factors and social distancing policies, using hierarchical multiple regression analyses controlling for sociodemographic variables. Results: Increases in planning (4.7 SD 1.3, 4.9 SD 1.3), selecting (3.6 SD 1.7, 3.7 SD 1.7), and preparing (4.6 SD 1.2, 4.7 SD 1.3) healthy foods were found for women and men, and positively related to perceived time availability and stay-at-home policies. Psychological distress was a barrier for women, and an enabler for men. Financial stress was a barrier and enabler depending on various sociodemographic variables (all p < 0.01). Conclusion: Stay-at-home policies and feelings of having more time during COVID-19 seem to have improved food literacy. Stress and other social distancing policies relate to food literacy in more complex ways, highlighting the necessity of a health equity lens. Copyright 2021 De Backer, Teunissen, Cuykx, Decorte, Pabian, Gerritsen, Matthys, Al Sabbah, Van Royen and the Corona Cooking Survey Study Group.This research was funded by the Research Foundation Flanders (G047518N) and Flanders Innovation and Entrepreneurship (HBC.2018.0397). These funding sources had no role in the design of the study, the analysis and interpretation of the data or the writing of, nor the decision to publish the manuscript.Scopu

Efficacy of sorghum peanut blend and corn soy blend plus in the treatment of moderate acute malnutrition in children aged 6&ndash;59 months in Karamoja, Uganda: a cluster randomized trial

Andrew Kiri Amegovu,1 Sophie Ochola,1 Patrick Ogwok,2 Peter Yiga,2 Juliet Musalima,2 Mandha Juliana2 1Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya; 2Department of Food Technology, Kyambogo University, Kampala, Uganda Abstract: More than half of the world&#39;s deaths in children below 5 years of age are caused by under nutrition. Early management of moderate acute malnutrition (MAM) is necessary to avoid deterioration to severe acute malnutrition. Corn soy blend plus (CSB+) mixed with vegetable oil and sugar is the traditional treatment for MAM but is too expensive for poor countries. The effectiveness of affordable and available local food materials are currently being studied as alternative food supplements to treat malnutrition. In this trial, the efficacy of sorghum peanut blend (SPB) mixed with ghee and honey for the treatment of MAM was compared to that of CSB+ among children 6&ndash;59 months old in Karamoja, Uganda. This was a single-blind randomized parallel trial in which two health centers were assigned on a 1:1 ratio to the two study groups. The participants (mothers and their moderately malnourished children) were recruited at the health centers and assigned to the groups depending on the health facility attended. Each child received a daily ration of either CSB+ or SPB for a maximum period of 3 months. Anthropometric measurements of the children were taken on a bi-weekly basis. The primary outcomes were the recovery rate and duration on the program before recovery. Of the recruited 440 participants, 392 completed the study and were included in the analysis (SPB group 194; CSB+ group 198). Analysis was by intention to treat. The recovery rates were not significantly different for the SPB group and the CSB+ group (82.3% and 76.8%, respectively; chi-square test P=0.093). Duration of recovery was significantly shorter for the SPB+ group, with a median of 43 days compared to 57 days for the SPB group (Kaplan&ndash;Meier survival test). The recovery rate and the duration of stay in the program were all within the acceptable Sphere Standards (&ge;75% and &le;90 days, respectively). SPB has the potential to treat MAM. Keywords: rehabilitation, Uganda, randomized trial, corn soy blend plus (CSB+), acute malnutritio