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Background: The heterogeneity of disease severity in peritonitis makes outcome prediction challenging. Risk evaluation in secondary peritonitis can direct treatment planning, predict outcomes and aid in the conduct of surgical audits. Objective: To determine the outcome of peritonitis in patients stratified according to disease severity at the Kenyatta National Hospital (KNH). Design: Prospective descriptive cross sectional survey. Methods: Seventy patients were consecutively enrolled within 24 hours of operation for peritonitis between December 2007 and April 2008. To stratify patients according to severity, Mannheim Peritonitis Index (MPI) scores were calculated using the following risk variables: age, sex, preoperative duration, organ failure, sepsis source, malignancy, character and extent of exudate. The main outcome on follow up was complications. Secondary outcomes were length of hospital stay and mortality for different MPI scores. Results: Fifty six males and 14 females (M:F=4:1) were analysed. The mean age was 32.17 years (age range 13-59 years). Forty six (65.7%) had generalised peritonitis, 15(21.4%) had 2-3 quadrant peritonitis while 9(12.9%) had focal peritonitis. Common sources of peritonitis were perforations of appendicitis (31.4%), duodenal ulcer (22.9%) and ileum (18.6%). Patients who complicated had a mean MPI of 26.9 compared to those who did not (22.8) (p=0.018). Morbidity rates increased with rising MPI scores (31% for MPI 29). The risk of death was double for patients with an MPI ≥26. Hospital stay was 14 days for the whole group but 22 days for those who developed complications. ROC curve analysis showed a predictive power of 0.916 with a sensitivity of 88.9% and specificity of 85.2% at MPI of 29 points. Conclusion: MPI scores related with outcomes of peritonitis and can be used in prognosticating early outcome in patients with surgical peritonitis at KNH.

Background: The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes.Methods: In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole.Results: A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediate-transfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P = 0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group.Conclusions: There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring. (Funded by the Medical Research Council and Department for International Development; TRACT Current Controlled Trials number, ISRCTN84086586.). [ABSTRACT FROM AUTHOR]

Background: The internet has led to the realization that the world is a global village. Due to technological advancements, anyone can access the internet and various video sharing platforms and in turn, get access to or share information across the world. One of the most sought-after critical pieces of information on the internet, as well as social media platforms, is information regarding wounds., Objective: To determine the views of patients with chronic wounds regarding the internet and other social media platforms as a source of information regarding wounds., Methodology: A descriptive prospective study covering the period between November 1, 2022, and January 30, 2023. All patients with chronic wounds presenting in the plastic outpatient clinic, together with patients presenting themselves in the wound clinic at Kenyatta National Hospital (KNH) during this period, were informed about the study and asked to participate. After consenting, they were then required to sign an informed consent form after agreeing to participate. Data collection was done through interviews and filled out in structured questionnaires. Data points included demographics, information on internet use, and interaction with the various social media platforms., Results: 83.4% of the participants were of the opinion that the contents shared were done so by professionals, compared to 12.5% who indicated that the owners or uploaders of the contents were laymen. 2.6% and 1.5%, on the other hand, opined that the owners or uploaders of the contents were unknown and difficult to tell, respectively., Discussion: The participants in the current study felt that some aspects regarding content on wounds that is shared on the internet as well as other social media platforms would need further improvement. Such areas included information regarding wound dressing concepts, the etiology and pathophysiology of wounds, complications of wounds, and wound pain management., (© 2023 The Author(s).)

Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Burn Association.)

Background: There is a paucity of data on asymptomatic carriage of Plasmodium parasite among adult population in Eastern Uganda, an area of perennial high transmission of malaria. In this study, we estimated the prevalence of Plasmodium parasites in donor blood units at Mbale Regional Blood Bank (Mbale RBB), a satellite centre of the Uganda Blood Transfusion Service (UBTS)., Method: This was a cross-sectional descriptive study in which 380 screened donor blood units were examined for the presence of Plasmodium parasites. A systematic random sampling technique using the interval of 7 was used in selecting the screened blood units for testing. Two experienced malaria slide microscopists (MC1 and MC2) independently examined each thick and thin blood slide under high power magnification of X400 and then X1000 as stated on the study standard operation procedure (SOP). Each slide was examined for 100 oil immersion fields before the examiner declared them negative for Plasmodium parasites. The results by each microscopist's examination were tallied separately, and finally, the two tallies were compared. The third independent microscopist (MC3) was blinded to the results from MC1 and MC2, but whose role was to perform quality control on the slides randomly sampled and read 38 (10%) of all the slides and was available to examine any slides with inconsistent findings by MC1 or MC2., Results: All the microscopists were unanimous in all the slide readings. Five of the thick smears (1.3%) confirmed the presence of Plasmodium parasites among donor blood units. Of these, 4/5 were from male donors. Plasmodium falciparum was identified in 4 positive samples, while Plasmodium malariae was identified in one of the donor units., Conclusion: The 1.3% prevalence of Plasmodium malaria parasites in screened donor blood units represents risk of malaria blood transfusion transmitted infection and a pool of community transmittable malaria infections, respectively.

Background: In sub-Saharan Africa, where infectious diseases and nutritional deficiencies are common, severe anaemia is a common cause of paediatric hospital admission, yet the evidence to support current treatment recommendations is limited. To avert overuse of blood products, the World Health Organisation advocates a conservative transfusion policy and recommends iron, folate and anti-helminthics at discharge. Outcomes are unsatisfactory with high rates of in-hospital mortality (9-10%), 6-month mortality and relapse (6%). A definitive trial to establish best transfusion and treatment strategies to prevent both early and delayed mortality and relapse is warranted., Methods/design: TRACT is a multicentre randomised controlled trial of 3954 children aged 2 months to 12 years admitted to hospital with severe anaemia (haemoglobin < 6 g/dl). Children will be enrolled over 2 years in 4 centres in Uganda and Malawi and followed for 6 months. The trial will simultaneously evaluate (in a factorial trial with a 3 x 2 x 2 design) 3 ways to reduce short-term and longer-term mortality and morbidity following admission to hospital with severe anaemia in African children. The trial will compare: (i) R1: liberal transfusion (30 ml/kg whole blood) versus conservative transfusion (20 ml/kg) versus no transfusion (control). The control is only for children with uncomplicated severe anaemia (haemoglobin 4-6 g/dl); (ii) R2: post-discharge multi-vitamin multi-mineral supplementation (including folate and iron) versus routine care (folate and iron) for 3 months; (iii) R3: post-discharge cotrimoxazole prophylaxis for 3 months versus no prophylaxis. All randomisations are open. Enrolment to the trial started September 2014 and is currently ongoing. Primary outcome is cumulative mortality to 4 weeks for the transfusion strategy comparisons, and to 6 months for the nutritional support/antibiotic prophylaxis comparisons. Secondary outcomes include mortality, morbidity (haematological correction, nutritional and infectious), safety and cost-effectiveness., Discussion: If confirmed by the trial, a cheap and widely available 'bundle' of effective interventions, directed at immediate and downstream consequences of severe anaemia, could lead to substantial reductions in mortality in a substantial number of African children hospitalised with severe anaemia every year, if widely implemented., Trial Registration: Current Controlled Trials ISRCTN84086586 , Approved 11 February 2013.