College of Medicine and Health Sciences

Association between lack of Intensive Care Unit (ICU) access and mortality in patients with combined assessment of risk encountered in surgery (cares) more than 20 points at CHUB and CHUK: a cohort study

Fri, 01 Jan 2021 00:00:00 GMT

Association between lack of Intensive Care Unit (ICU) access and mortality in patients with combined assessment of risk encountered in surgery (cares) more than 20 points at CHUB and CHUK: a cohort study Manirabona, Emmanuel Background Lack of access to intensive care unit (ICU) for both surgical and non-surgical patients is common in countries with limited resources. In the current literature, there is a paucity of published data on the outcome of patients who lacked access to ICU while they were having criteria for critical management after surgery. The aim of this study was to assess the mortality and length of hospital stay for patients with a combined assessment of risk encountered in surgery (CARES) >20 points who had surgery and lacked access to ICU in comparison to those who got admission to ICU Methods This was a prospective comparative cohort study carried out in two university teaching hospitals which are Butare University Teaching Hospital(CHUB) and Kigali University Teaching Hospital (CHUK) over 10 months’ period, from June 2020 to April 2021. All participants were followed in-hospital till discharge, death or till 30 days postop whichever came first. Mortality and length of in-hospital stay were recorded and compared in ICU access and non -ICU access groups. Data analysis was done using SPSS version 25.0 (IBM Corporation, New York 10504-1722, USA). Percentages and means were used for descriptive statistics. For categorical variables with comparison groups, chi-square test was used. For continuous variables, t-test and ANOVA test were used to compare means among groups. A p–value of 0.05 or less was considered statistically significant. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression analysis. Results: In total 708 acute care surgery (ACS) patients were evaluated using CARES surgical risk calculator and 213 patients had CARES> 20 points and were enrolled in the study. 82 patients had post-operative ICU access timely or delayed while 130 did not have access to critical care service after operation and 1 patient has died intraoperatively. x Mortality rate among patients who had immediate post-operative ICU admission was 26.4% versus 89.7% for those who had delayed admission and 48.1% in no ICU access group. Delayed ICU admission increases mortality by 24-fold (95% CI, 6.304-92.393, p-value 20 points. Early management, preoperative ICU bed booking and timely ICU admission may considerably decrease mortality and morbidity. We recommend to increase ICU capacity for both CHUB and CHUK, improve preoperative evaluation of all surgical emergencies and create a dedicated area for suitable monitoring and management for critically ill surgical patients when access to ICU is limited or unavailable Master's Dissertation

Assessing the illicit drugs used and factors influencing its use in Rwanda’’

Fri, 01 Jan 2021 00:00:00 GMT

Assessing the illicit drugs used and factors influencing its use in Rwanda’’ NIYIGENA, Audace Even though if Illicit drugs are prohibited universally. In 2017, an estimated 271 million representing 5.5 per cent of people worldwide aged 15–64 have used drugs at least once in the previous month. In Rwanda a study done in 2015 showed a percentage of substance dependences of 7.46% for alcohol, 4.88% for nicotine and 2.54% for cannabis dependency, in teenagers and young adults. The product used by a Substance Use Disorder patient, is important to be identified so that appropriate counseling and pharmacotherapy can be offered. Unfortunately as for today the available illicit drugs on the Rwandan market are still unknown. The aim of this study was to feel the gap in addiction data by producing an exhaustive list of illicit drugs available and factors influencing their use in Rwanda. This research was conceived as qualitative study. And a survey was conducted on patients diagnosed with SUD admitted or consulting the Icyizere center. All participants used illicit drugs for at least two years and didn’t know each other before they meet in Icyizere therapeutic center. Numerus illicit drugs was identified: Marijuana, Heroin, Cocaine, benzodiazepine, Cap, LSD, Gasoline, Glue, Khat, Alcohol, 36 oiseaux …. Some of them are at high risk of overdose and some treatment are not available in Rwanda. Factors identified leading to the use of illicit drugs was mainly due to lack of accurate information on drugs in the child and teenager hoods and miss-information spread by experienced drug users on the benefits of using drugs Master's Dissertation

Incidence and risk factors for perioperative blood transfusion in total knee and hip arthroplasties in Rwanda

Fri, 01 Jan 2021 00:00:00 GMT

Incidence and risk factors for perioperative blood transfusion in total knee and hip arthroplasties in Rwanda NSHIMIYIMANA, Joseph Introduction: Perioperative transfusion of blood cells in total joints arthroplasty (TJA) continues to present a major concern despite the global strategies to minimize its utilization and related complications developed to improve patients‟ safety and outcomes. This study intends to determine the incidence and identify factors which are associated with perioperative transfusion of PRBCs in unilateral primary total hip and total knee arthroplasties (THA, TKA) in Rwanda. Methods: 133 patients who have undergone either a primary THA or TKA at King Faisal Hospital Rwanda (KFHR) between February/2020 and February/2021 were prospectively analyzed. Patients‟ demographics, preoperative clinical information including diagnoses, comorbidities and laboratory data were recorded preoperatively. Other information about the allogeneic blood transfusion was recorded in intraoperative and postoperative periods before discharge, a 48 hours drain output was also recorded. Statistical analysis was used to determine the incidence and identify the risk factors which are related with utilization of PRBCS transfusion in TJA. Results: A total number of 133 participants are enrolled and included in our analysis, THA were carried out in 92 (69.2%) patients, while 41 (31.8%) were undergone TKA. The overall blood transfusion rate was 41.4 % in total major joints (hip and knee) arthroplasty (p<0.001), 44.6% and 34.2% in THA and TKA (p<0.001) respectively. Factors like hypertension (p<0.001), diabetes mellitus concomitant with hypertension (p<0.001) were associated with high rate of transfusion along with diagnosis of hip osteoarthritis (p<0.001) and neck of femur fracture (p<0.001). A low baseline Hemoglobin (Hb) (p<0.001) level, an increased amount of intraoperative blood loss (p < 0.019) and prolonged length of operation (p<0.001) are attributable to perioperative PRBCs transfusion in THA. The similar factors contributed to PRBCs transfusion in TKA group, in addition with female gender (p<0.001) and diagnosis of knee OA (p<0.001). Conclusion: The overall incidence of blood transfusion in both total hip and knee arthroplasty is slightly high in our settings; anticipation of blood transfusion by treating surgeon should always be considered and correlated with individual patients‟ risk factors attributable to the needs of blood transfusion during or after TJA. Master's Dissertation

Risk factors associated with pneumonia among under five children at selected district hospital in Kigali/Rwanda

Fri, 01 Jan 2021 00:00:00 GMT

Risk factors associated with pneumonia among under five children at selected district hospital in Kigali/Rwanda Turatsinze, Emile Background: The delays to surgery are a global health problem, especially in trauma patients, given injuries are currently a major cause of deaths worldwide. However, the status of emergency orthopedic surgical delays in the Rwandan hospitals is not known. This study aims at describing the factors associated surgical treatment delays in emergency trauma patients received at the emergency of CHUK, the largest referral hospital in Rwanda. Methods: This was a single center cross-sectional study, conducted at the CHUK accident and emergency department, in the orthopedic unit. A sample of 112 patients was recruited. We recorded demographic data and injury characteristics. We evaluated the timing status between the injury and surgery, and we analyzed the factors associated with delayed surgery using a logistic regression model made of a full model containing all covariates and a final, reduced model containing only significant independent variables determined using a backward model selection approach. The goodness of fit was assessed using the Hosmer Lemeshow test. The model validation was done using training dataset (70%) and test dataset (30%) through the comparison of conclusions from them. Results: A total number of 112 patients constitutes our study sample size, 60 % of them were from the capital city, Kigali.72.32% were males while 27.68% were females. 26.79% of selected patients had no insurance. 57% of our patients had open fractures, with the median time from injury to surgery being 2 days; while 48.65 % had closed fractures with the median time from injury to surgery was 4 days. In general, 64.22% of cases were delayed to have surgery. The majority of delayed patients had open fractures (37 patients) while 32 patients had closed fractures. Delays were commonly associated with lack of theater slot, lack of health insurance and other challenges like lack of implants, lack of sterile equipment and lack of experienced surgeon. Conclusion: surgery delay was related to both patient and institutional factors. These included patients lacking a health insurance, lack of theater slots, lack of implants, insufficient staff as well as lack of orthopedic emergency patient flow system. Improved community health insurance sensitization, increasing the infrastructure and personnel, and better usage of available resources would help in decreasing the amount of delays Master's Dissertation