scholarly journals Incidence of Post Dural Puncture Headache and Associated Factors Following Spinal Anaesthesia for Caesarean Delivery in Mulago National Referral Hospital

2019 ◽  
Author(s):  
Philo Nambooze ◽  
Kizito Samuel ◽  
John Baptist Kiggundu ◽  
Andrew Kintu ◽  
Mary T. Nabukenya
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Associated Factors ◽  
Dural Puncture ◽  
Cost Effective ◽  
Referral Hospital ◽  
P Value ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

scholarly journals Incidence Of Post Dural Puncture Headache And Associated Factors Following Spinal Anaesthesia For Caesarean Delivery In Mulago National Referral Hospital

2019 ◽  
Author(s):  
Philo Nambooze ◽  
Kizito Samuel ◽  
John Baptist Kiggundu ◽  
Andrew Kintu ◽  
Mary T. Nabukenya
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Associated Factors ◽  
Dural Puncture ◽  
Cost Effective ◽  
Referral Hospital ◽  
P Value ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

scholarly journals Quality of life and Associated Factors among Children aged 5 to 18 years with Diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital

2019 ◽  
Vol 4 (6) ◽  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Associated Factors ◽  
P Value ◽  
Factors Associated ◽  
Mulago National Referral Hospital ◽  
Biological Parents ◽  
National Referral Hospital

Background: This study aimed to determine the quality of life and describe associated factors among children aged 5-18 years with diabetes Mellitus at St. Francis Hospital Nsambya and Mulago National Referral Hospital. Methods: An explanatory sequential study design was used between November 2018 and March 2019. Univariate analysis together with bivariate logistic regression analysis was used to determine quality of life and identify association between the quality of life at a p-value ˂ 0.05 respectively. Factors found to have a p-value ˂ 0.25 were included in the Multivariate logistic regression. A backward method was then applied to determine the best model that predicts quality of life among children. Data was analysed using STATA version 14. Data on the perception of quality of life of children with diabetes mellitus from the perspective of the children, caregivers and health workers was used to obtain qualitative results. Results: 115 children were recruited from the paediatric diabetic clinics. A low quality of life with a mean score of 77 ±15.58 was reported with a mean age of 13 ± 3.9. Factors associated with quality of life included: age groups of 8-12 and 13-18 years, primary education, secondary education, tertiary education, a single parent, living with relatives and primary care giver being a relative other than the biological parents. Conclusion: A sub-optimal quality of life was observed among children with type 1 diabetes mellitus. The factors associated with good quality of life included; age between 5- 7 years, a child living with biological parents, a child being in primary school and higher parental level of education. Recommendation: Community health education and sensitization should be more focused towards the adolescent patients, single mothers, guardians and benefactors of children with diabetes mellitus. There is greater need for healthcare support in schools to mitigate the stigma experienced by these children.

scholarly journals Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

2021 ◽  
Vol 7 (1) ◽  
pp. 16-23
Author(s):  
Tenzin Yoezer ◽  
Karma Tenzin ◽  
Jampel Tshering ◽  
Yin Min Than ◽  
Kuenza P Wangmo
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cesarean Section ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Significant Risk ◽  
Referral Hospital ◽  
P Value ◽  
Fasting Duration ◽  
National Referral Hospital

Introduction: The current choice of anesthesia for the cesarean section is spinal anesthesia. However, hypotension is the major complication. If promptly not recognized and treated, it increases the morbidity and mortality of the mother and fetus. This study was conducted to evaluate the rate of pre-delivery hypotension and risk factors following spinal anesthesia for cesarean section at the National Referral Hospital in Bhutan. Methods: A cohort study was conducted from 1st October 2018 to 30th June 2019 on 350 women undergoing cesarean section under spinal anesthesia. Pre-delivery hypotension was defined as systolic blood pressure < 100 mm Hg. The association of factors for hypotension was tested using multivariable binary logistic regression using a forward stepwise model. A p-value < 0.05 was considered significant. Results: The rate of pre-delivery hypotension was 74.6 % (n=261). History of hypertension during pregnancy (Adjusted OR 0.25, [0.11-0.60], p=0.013), prophylaxis use of ephedrine (Adjusted OR 0.45, [0.22-0.92], p= 0.024) and ondansetron (Adjusted OR 0.43, [0.22-0.82], p= 0.010),longer preoperative fasting duration (Adjusted OR 1.12, [1.01-1.21], p=0.024,), sensory block level <= T4 (Adjusted OR 3.4, [1.8-6.4], p=<0.001) and baseline systolic blood pressure less than or equal to 120 mmHg (Adjusted OR 2.8, [1.5-5.1], p=0.001) were significant risk factors.  Conclusions: This study conduces that the rate of pre-delivery hypotension following spinal anesthesia in a cesarean section was high among women undergoing cesarean section. It is alarming as around two-third of women and fetus undergoing cesarean section under spinal anesthesia are at risk of consequences of hypotension. Most of the risk factors in the study are modifiable. The study suggests that if the anesthesia provider intervenes in managing the modifiable risk factors and treat hypotension promptly, it can help reduce the risk of women and fetus to spinal hypotension consequences.

scholarly journals Effect of Hydrocortisone on Reducing severity of Post Dural Puncture Headache after Spinal Anesthesia for Elective Caesarean Section

2018 ◽  
Vol 23 (4) ◽  
pp. 468-472
Author(s):  
Shumaila Ashfaq ◽  
Liaqat Ali ◽  
Muhammad Ashraf Zia ◽  
Rizwan Ahmad Khan ◽  
Mehtash Butt
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Conventional Treatment ◽  
Dural Puncture ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Post Dural Puncture Headache ◽  
Group A ◽  
Group B

Spinal anesthesia is frequently used in pregnant female undergoing caesarean section due to its safety than general anaesthesia. Post dural puncture headache (PDPH) is commonly occurring problem associated with spinal anaesthesia and causes a considerable morbidity. PDPH depends on several factor and various methods have been used to reduce and treat the pain of PDPH. We evaluated effects of hydrocortisone on the treatment of PDPH in obstetrical patient. To compare mean decrease in Visual Analogue Scalepain score in patients who developed PDPH after elective caesarean section under spinal anaesthesia who were given conventional treatment versus conventional treatment plus hydrocortisone. Double blind randomized control trial. Study conducted in department of anaesthesia and obstetrics of Allama Iqbal Medical College, Jinnah hospital (tertiary care) conducted from13th June 2014 to 13th December 2014. Sample size was calculated 60 (30 each) cases using 95% confidence interval, 80% power of test. Patients who developed PDPH after spinal anaesthesia for elective caesarean section were divided into 2 group; Group A (Conventional Treatment) and Group B, (Conventional Treatment plus Hydrocortisone 100mg 8 hourly for 48 hours). Details were recorded regarding age; mean pretreatment and post treatment VAS after 6 hours. Mean decrease in pain VAS score was 3.30 + 1.2 in group A while 7.17+ 1.3 in group B. (P value 0.001). Intravenous hydrocortisone is more effective in reducing post dural puncture headache pain severity after spinal anaesthesia for elective caesarean section when given along with conventional treatment as compared to conventional treatment alone.

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 28-31
Author(s):  
Chetan Bohara ◽  
Rajesh Maharjan ◽  
Subi Regmi ◽  
Gunjan Regmi ◽  
Rajendra Kunwar ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Dural Puncture ◽  
P Value ◽  
Sitting Position ◽  
Post Dural Puncture Headache ◽  
Subarachnoid Block ◽  
Group A ◽  
Group B

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip.  The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles. Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block. Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache. Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

scholarly journals High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda

2021 ◽  
Vol 09 (07) ◽  
pp. E997-E1000
Author(s):  
Ronald Mbiine ◽  
Cephas Nakanwagi ◽  
Olivia Kituuka
Keyword(s):  
Positive Association ◽  
Referral Hospital ◽  
Outcome Variable ◽  
Mulago Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Female Ratio ◽  
Mulago National Referral Hospital ◽  
Male To Female ◽  
Upper Gastrointestinal ◽  
National Referral Hospital

Abstract Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant (P = 0.006 and (P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.

scholarly journals Pre-injury alcohol use and road traffic injury among patients at Mulago National Referral Hospital, Kampala, Uganda: Cross-sectional study

2019 ◽  
Vol 30 (4) ◽  
pp. 17-25 ◽  
Author(s):  
Claire Biribawa ◽  
Olive Kobusingye ◽  
Possy Mugyenyi ◽  
Ezekiel Baguma ◽  
Emmanuel Bua ◽  
...  
Keyword(s):  
Emergency Department ◽  
Alcohol Use ◽  
Road Traffic ◽  
Alcohol Intoxication ◽  
Referral Hospital ◽  
High Rate ◽  
Traffic Injury ◽  
Mulago National Referral Hospital ◽  
Injured Patients ◽  
National Referral Hospital

Background: Uganda has a high rate of road traffic injuries (RTI). Alcohol use increases traffic injury risk and severity through impairment of road-use skills and hazard perception. Few studies have examined this problem in Uganda. We therefore assessed the prevalence and determinants of pre-injury alcohol use among road traffic injured patients at Mulago National Referral Hospital, Kampala Uganda. Methods: We enrolled 330 eligible adult RTI patients consecutively in a crosssectional study, at the emergency department in Mulago National Referral Hospital from March-May, 2016. We assessed pre-injury alcohol use using BACtrack professional Breathalyzer, alcohol intoxication assessment tool and alcohol use selfreport covering the period of 6 hours before the injury. We assessed injury severity using Glasgow Coma Scale and Kampala Trauma Score. We estimated prevalence ratios [PR] using modified Poisson regression. Results: Prevalence of pre-injury alcohol use among injured patients was 29.7%. Pedestrians (44%) had the greatest percentage of alcohol use when compared to other road users. Pre-injury alcohol use was associated with mortality at the Emergency Department, PR: 2.33 [1.39 – 3.9]. Conclusion and recommendations: Pre-injury alcohol use is high among pedestrians and yet prevention efforts target mostly motorists. Pre-injury alcohol use also resulted into increased mortality at Emergency Department. We recommend prevention efforts to not only target motorists but also pedestrians.

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