Victor Meza Kyaruzi

Functional outcomes after definitive surgical reconstruction in the management of Anorectal malformations (ARM) patients have not been adequately studied in the third-world countries. This retrospective cross sectional analytical study aimed at evaluating the functional outcome and attributable factors following the definitive reconstruction surgery among children with ARM at Muhimbili National Hospital. Patients with ARM who underwent definitive reconstruction surgery between 2017 and 2021 were recruited in the current study using the consecutive sampling method. The functional outcome and severity were assessed using the modified Krickenbeck scoring system.Analysis was performed using STATA version 16.0. 116 pediatric patients with ARM who underwent definitive surgical repair were reviewed, the mean age was 4.4 (SD1.8) years. The male-to-female ratio was 1.1:1. The functional outcome was voluntary bowel movement (VBM), constipation, and soiling with a prevalence of 63%, 22%, and 15% of patients respectively. Babies born preterm shows significant association with constipation with P- the value of 0.003, OR 13.26, and 95% CI 2.48–70.87. Abdominal perineal pull-through among patients who had High ARM showed a significant association with soiling (P-value 0.001, OR 0.03, and 95% CI of 0.01–0.16). In the current study we identified that there is no significant variation in ARM functional outcome between males and females.However some factors such as the type of surgery, patient body weight and the complexity of anorectal malformation were all decisive factors for achieving the optimum Voluntary Bowel Bovement (VBM) following ARM repair surgery.

Background: A flexible bronchoscopy is an essential tool that is globally used for the diagnosis and treatment of Broncho-pulmonary diseases. However the indication and outcome of flexible bronchoscopy has not been widely documented in majority of low resource settings.Objective: To determine the indications and outcome of flexible bronchoscopy (FB) at Muhimbili National Hospital (MNH).Methodology: A cross sectional analytical study was conducted for a period of 12months. Details involving indications and outcome of flexible bronchoscopy includes; bronchoscopy findings, therapeutic value, diagnostic yield, and early procedural related complications together with their demographic data were documented after each procedure followed by analysis using SPSS version 25.Results: Among 151 patients underwent flexible bronchoscopy 76(50.30%) were male and 75(49.70%) were female. The median age of 58 years with IQR (43, 65). Among the indications of flexible bronchoscopy, Cough and hemoptysis were the leading by 124(82.10%) and 38(25.20%) respectively. On the other hand hyperemic mucosa 47(31.10%) and endobronchial mass 32(21.20%) constituted the majority of the bronchoscopy findings. The overall diagnostic yield was 34.3% and procedural related complications was 18.54%. Among the indications for flexible bronchoscopy, the hemoptysis was associated with procedure related complications by 48(31.6%) OR (95%CI),2.779 (2.339-3.219) p<.020. Among sampling technique of flexible bronchoscopy, the endobronchial biopsy and bronchi alveolar lavage (BAL) sampling technique were associated with procedure related complications by 60(39.5%), OR (95%CI), 4.393 (3.957-4.829) p <.001 and 22(14.70%),OR (95%CI) 1.870 (1.656-2.084) p<.005 respectively .Conclusion: We have demonstrated that flexible bronchoscopy is a safe and reliable procedure in diagnosis of respiratory maladies including Mycobacterium tuberculosis (MTB) at Muhimbili National Hospital.

Introduction Chronic subdural hematoma (cSDH) is a common neurosurgical condition characterised by the accumulation of blood between the dura mater and the arachnoid membrane. It has a significant prevalence and high mortality. Over the years, the management of cSDH has been extensively studied in high-income countries. On the other hand, Africa, which is faced with a significant neurosurgical care deficit, lacks aggregate data on the management strategies and outcomes on cSDH on this continent. This protocol aims to guide the scoping review of published studies investigating the characteristics, management strategies, and outcomes of cSDH in Africa. Methods and Analysis The scoping review protocol for the proposed study is in accordance with the Arksey and O’Malley’s framework. The objectives, eligibility criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A comprehensive search will be conducted in electronic databases, including MEDLine, African Index Medicus, PubMed, Embase, African Journals Online, and Scopus to identify relevant studies. Only peer-reviewed publications with primary data reporting on the management of cSDH in the African human population will be included. Extracted data from included articles will be presented as descriptive statistics, pooled statistics, and a narrative description where deemed necessary. Ethics and dissemination Given the non-direct involvement of human individuals, ethical approval will not be necessary. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at conferences and promotion over social media. Study strengths and limitations To our knowledge this is the first scoping review focusing on the management and outcomes of chronic subdural haematoma on the African continent. This protocol aims at ensuring transparency in the research methods used for the proposed review, and this will therefore reduce the chances of reviewing bias. The search strategy will be run in six electronic databases commonly used as repositories by journals publishing research from Africa. There will be no restrictions on language, and publication date during the screening process. Unpublished studies will not be sought. There will be no formal assessment on the quality of the included studies.

Purpose: This study aimed to assess and compare the in-hospital recovery times between two groups: those exposed to early intervention and those with late intervention in a cohort of Traumatic Brain Injury (TBI) patients requiring urgent neurosurgical intervention in ALERT Trauma Center in Addis Ababa, Ethiopia. Methods: The study was conducted over seven consecutive months, from March 14, 2020, to October 13, 2020. Patients were consecutively recruited from the emergency department until the final sample size was fulfilled. The recovery time between the early and late surgery groups was compared using the Log rank test. The Cox proportional hazard model was used to analyze the event data, with the assumption of proportional hazards being checked. The measure of effect was reported using the adjusted hazard ratio, and a stepwise approach was used to build the final model. Results: A total of 117 TBI patients undergoing urgent neurosurgical intervention were observed and the median survival time for the early surgery group was 4.1 days, and for the late surgery group, it was 6.4 days, with no statistically significant difference (CHR: 0.73; 95% CI; 0.47– 1.11). On the other hand, severe TBI grade emerged as a significant independent predictor, indicating an 86% lower rate of recovery compared to mild TBI cases. Additionally, higher diastolic blood pressure within the range of 50 to 100 was associated with a 24% increased rate of recovery. Conclusion: This study identified factors influencing recovery outcomes and predictors of prolonged recovery, specifically severe TBI grade and lower diastolic blood pressure. The results emphasize the importance of timely intervention and provide specific considerations for optimizing patient outcomes in TBI cases and guiding further research in the area.

This study seeks to gather evidence-based information on the therapeutic effect of dendritic cell vaccines in treating glioblastoma. This protocol will follow the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline for 2020. In this review, we determined four primary central databases as sources of information: PubMed, Embase, Scopus and the Cochrane Central Register of Controlled Trials. Ethical approval for this study was unnecessary, as we already used published studies. Study findings will be published in journals and presented at conferences for broader dissemination. Highlights The most common and dangerous primary malignant brain tumor, glioblastomas (GBM), are still tricky and challenging to treat. Even with multimodal treatment, victims’ median survival is just 15 months. Active immunotherapy called dendritic cell vaccines (DCV) aims to trigger an anticancer immune system reaction. Hundreds of GBM patients have been vaccinated in numerous DCV trials, which have confirmed the vaccine’s viability and safety. This study aims to assess the rationalistic effect of dendritic cell vaccines for treating GBM.

Malignant gliomas are the most angiogenic aggressive tumours with high proliferative and invasion phenotypes. Total microvessel density, the combination of the microvascular density and the vasculogenic mimicry status, is a biomarker closely associated with the aggressiveness of a tumour including its invasive and metastatic potential. This review aims to investigate the relationship between vasculogenic mimicry and microvascular density, and its association with prognosis and therapeutic response in gliomas across the available randomized clinical trials (RCTs) and cross-sectional studies to optimize the strength of evidence for underpinning the strategy for treating tumours. We will conduct the Systematic and Meta-analysis by employing the provisions of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guideline and the review protocol will be submitted to International Prospective Register of Systematic Reviews (PROSPERO) for registration before commencement of the study. We will construct the search strategy using a combination of ‘glioma’, ‘microvascular density’, ‘vasculogenic mimicry’, ‘prognostic significance’ and ‘therapeutic response’ from the four databases (Scopus, EMBASE, PubMed and Cochrane Library). This review will be conducted without the involvement of human participants, making ethical clearance approval inapplicable. The protocol for this review will be duly registered with the PROSPERO registry. The final report of this review will be shared at scientific conferences, both locally and internationally, and the protocol and final results will be published in a reputable Neurosurgery journal.

Background: Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). Methods: A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Results: Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. Conclusion: EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH.

Managing sellar and suprasellar tumors is challenging due to their diverse origins and proximity to critical structures. The transsphenoidal surgical approach has become the preferred method, evolving from transcranial attempts to reduce morbidity. Microscopic transsphenoidal techniques have been refined over time, with endoscopic endonasal surgery emerging as a significant advancement. Due to the multifaceted nature of these approaches, the complexities of the pathology and the paucity of data from specific regions, understanding the prevalence, characteristics and management outcomes of sellar and suprasellar tumors is crucial for informing healthcare practices and resource allocation. This study aims to collate evidence-based insights into the efficacy of the endoscopic endonasal approach compared with the microscopic transsphenoidal approach as a surgical intervention for sellar and suprasellar tumors, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for 2020. To source pertinent information, we will rely on four primary central databases: PubMed, EMBASE, SCOPUS and the Cochrane Central Register of Controlled Trials. The primary outcome measure will be the surgical outcome’s effectiveness in achieving tumor resection and preserving pituitary function. The study protocol is duly registered with the International Prospective Register of Systematic Reviews (PROSPERO), with no requirement for ethical approval as it exclusively relies on previously published research. We aim to publish our findings in scientific journals and present the abstract at conferences to guide clinical practice. PROSPERO Registration Number: CRD42023461972: available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023461972.

The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy of the score and its correlation with the complication severity has not been well established in many grounds of low resource settings. To determine the accuracy of Surgical Apgar Score in predicting the severity of post-operative complications among patients undergoing emergency laparotomy at Muhimbili National Hospital. A prospective cohort study was conducted for a period of 12 months; patients were followed for 30 days, the risk of complication was classified using the Surgical Apgar Score (SAS), severity of complication was estimated using the Clavien Dindo Classification (CDC) grading scheme and Comprehensive Complication Index (CCI). Spearman correlation and simple linear regression statistic models were applied to establish the relationship between Surgical Apgar Score (SAS) and Comprehensive Complication Index (CCI). The Accuracy of SAS was evaluated by determining its discriminatory capacity on Receiver Operating Characteristics (ROC) curve, data normality was tested by Shapiro–Wilk statistic 0.929 (p < 0.001).Analysis was done using International Business Machine Statistical Product and Service Solution (IBM SPSS) version 27. Out of the 111 patients who underwent emergency laparotomy, 71 (64%) were Male and the median age (IQR) was 49 (36, 59).The mean SAS was 4.86 (± 1.29) and the median CCI (IQR) was 36.20 (26.2, 42.40). Patients in the high-risk SAS group (0–4) were more likely to experience severe and life-threatening complications, with a mean CCI of 53.3 (95% CI: 47.2–63.4), compared to the low-risk SAS group (7–10) with a mean CCI of 21.0 (95% CI: 5.3–36.2). A negative correlation was observed between SAS and CCI, with a Spearman r of -0.575 (p < 0.001) and a regression coefficient b of -11.5 (p < 0.001). The SAS demonstrated good accuracy in predicting post-operative complications, with an area under the curve of 0.712 (95% CI: 0.523–0.902, p < 0.001) on the ROC. This study has demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital.

Traumatic brain injury (TBI) is a significant public health threat, with an estimated 5.3 million people in the United States alone living with a disability related to TBI (1). The most common therapies for individuals with TBI at this time include supportive measures, direct monitoring and surgical interventions, but the treatment outcomes following TBI are still poor. Atorvastatin is one of 3-hydroxy–3-methylglutaryl coenzyme A reductase inhibitors commonly used for treatment reduction of low-density lipoprotein and relief of symptoms in cerebrovascular diseases, however, the recent randomized trials in animal models and human subjects have revealed a promising therapeutic effect for its use in the treatment of TBI that has shown a significant alleviation of neurological dysfunctions. Hence, this systematic review will streamline and provide a comprehensive avenue for understanding more about the dynamics of atorvastatin and its neuroprotective efficacy for the treatment of the severity of TBI and the improvement of functional outcomes. This systematic review will follow the 2020 PRISMA guidelines. Information sources will be obtained from electronic databases such as Pubmed, Cochrane Library, EMBASE and SCOPUS. All patients with TBI that received Atorvastatin will be included. The review will also include original peer-reviewed research articles addressing the efficacy of Atorvastatin in TBI in English. Ethical approval will not be required as there will be no human participant involvement in this study. The findings from this study will be disseminated at scientific conferences and published in a reputable peer-reviewed journal.Strengths A wide range of study types will be included increasing the pool of information.Accuracy will be upheld as two to three reviewers will independently screen titles, abstracts and full texts.Limitations Only studies in English will be included, hence studies in other languages that may be very informative will be excluded.