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Abstract Background Neonatal sepsis contributes significantly to morbidity and mortality among young infants. The aetiological agents as well as their susceptibility to antimicrobial agents are dynamic. This study determined aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis at Muhimbili National Hospital. Methods Three hundred and thirty neonates admitted at the Muhimbili National Hospital neonatal ward between October, 2009 and January, 2010 were recruited. Standardized questionnaires were used to obtain demographic and clinical information. Blood and pus samples were cultured on MacConkey, blood and chocolate agars and bacteria were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial sensitivity testing was performed for ampicillin, cloxacillin, gentamicin, amikacin, cefuroxime and ceftriaxone on Mueller Hinton agar using the Kirby Bauer diffusion method. Results Culture proven sepsis was noted in 24% (74/330) of the study participants. Isolated bacterial pathogens were predominantly Staphylococcus aureus, Klebsiella spp and Escherichia coli. Klebsiella spp 32.7% (17/52) was the predominant blood culture isolate in neonates aged below seven days while Staphylococcus aureus 54.5% (12/22) was commonest among those aged above seven days. Staphylococcus aureus was the predominant pus swabs isolate for both neonates aged 0–6 days 42.2% (98/232) and 7–28 days 52.3% (34/65). Resistance of blood culture isolates was high to ampicillin 81.1% (60/74) and cloxacillin 78.4% (58/74), moderate to ceftriaxone 14.9% (11/74) and cefuroxime 18.9% (14/74), and low to amikacin 1.3% (1/74). Isolates from swabs had high resistance to ampicillin 89.9% (267/297) and cloxacillin 85.2 (253/297), moderate resistance to ceftriaxone 38.0% (113/297) and cefuroxime 36.0% (107/297), and low resistance to amikacin 4.7% (14/297). Sepsis was higher in neonates with fever and hypothermia (p=0.02), skin pustules (p Conclusions Staphylococcus aureus was predominant isolate followed by Klebsiella and Escherichia coli. There was high resistance to ampicillin and cloxacillin. Mortality rate due to neonatal sepsis was high in our setting. Routine antimicrobial surveillance should guide the choice of antibiotics for empirical treatment of neonatal sepsis.

Medulloblastoma, one of the most malignant brain tumors in children, is thought to arise from undifferentiated neural stem/progenitor cells (NSCs) present in the external granule layer of the cerebellum. However, the mechanism of tumorigenesis remains unknown for the majority of medulloblastomas. In this study, we found that many human medulloblastomas express significantly elevated levels of both myc oncogenes, regulators of neural progenitor proliferation, and REST/NRSF, a transcriptional repressor of neuronal differentiation genes. Previous studies have shown that neither c-Myc nor REST/NRSF alone could cause tumor formation. To determine whether c-Myc and REST/NRSF act together to cause medulloblastomas, we used a previously established cell line derived from external granule layer stem cells transduced with activated c-myc (NSC-M). These immortalized NSCs were able to differentiate into neurons in vitro. In contrast, when the cells were engineered to express a doxycycline-regulated REST/NRSF transgene (NSC-M-R), they no longer underwent terminal neuronal differentiation in vitro. When injected into intracranial locations in mice, the NSC-M cells did not form tumors either in the cerebellum or in the cerebral cortex. In contrast, the NSC-M-R cells did produce tumors in the cerebellum, the site of human medulloblastoma formation, but not when injected into the cerebral cortex. Furthermore, the NSC-M-R tumors were blocked from terminal neuronal differentiation. In addition, countering REST/NRSF function blocked the tumorigenic potential of NSC-M-R cells. To our knowledge, this is the first study in which abnormal expression of a sequence-specific DNA-binding transcriptional repressor has been shown to contribute directly to brain tumor formation. Our findings indicate that abnormal expression of REST/NRSF and Myc in NSCs causes cerebellum-specific tumors by blocking neuronal differentiation and thus maintaining the "stemness" of these cells. Furthermore, these results suggest that such a mechanism plays a role in the formation of human medulloblastoma. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) is a common source of morbidity among operated patients. At Muhimbili National Hospital (MNH), studies indicate that the rate of SSI has been increasing over the past thirty years. The aim of this study was to determine the prevalence and factors associated with SSI among patients undergoing surgery at MNH. Methods: This was a hospital-based cross-sectional study. One hundred and eighteen patients who underwent surgical procedures in the surgical wards were recruited. Demographic information was obtained using standardised questionnaire, surgical sites were examined to determine infections, and case notes were reviewed for clinical information including surgical notes. Blood sample was collected for HIV serology. Results: SSI occurred in 42 patients (35.6%). Wound class, abdominal surgeries, emergency procedures and HIV infection increased the risk of SSI. Superficial SSI was the most commonly observed type, 54.8%. Overall HIV prevalence in this study was 16.9% with a 5 times risk of developing SSI. Conclusions: Surgical site infection has remained a major Nosocomial infection in developing countries. Factors shown to be associated with increased risk are wound class, site and nature of surgery, and HIV infection. This study found higher prevalence of HIV infection among surgical patients. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO) is a well-known complication of total hip arthroplasty (THA), especially when the direct lateral approach is used. In this study, we examined the effect of the selective COX-2 inhibitor, celecoxib, on the rates of HO after THA. A control group consisting of 108 patients that did not receive celecoxib was compared with a study group consisting of 106 patients that did receive celecoxib. We assessed the presence and grade of HO using the Brooker classification and Harris hip scores were determined pre- and postoperatively to better quantify clinical outcomes. In this retrospective study of prospectively collected data, celecoxib is associated with a significant reduction in the incidence of HO in patients undergoing THA. [ABSTRACT FROM AUTHOR]

After approval of the Subolesin-based anti-tick vaccine in Uganda, we completed a one-year follow-up evaluation study. The results showed significantly 2.1-5.0-fold higher anti-SUB IgG antibody titers in vaccinated cattle in Mbarara and Maruzi with vaccine effectiveness higher than 95 %. In Mbarara, total number of ticks were 0.8-fold lower in vaccinated cattle with a negative correlation tendency between anti-SUB antibody titers and tick counts. The CCHFV-seropositive cattle significantly decreased in 40 % in SUB-vaccinated animals with a significant positive correlation between CCHFV-seropositive cattle and the total number of ticks per animal and a negative correlation tendency between anti-SUB antibody titers and CCHFV-seropositive cattle. A boosting vaccine dose yearly after primary vaccination with three doses is sufficient to maintain protective antibody titers against ticks and tick-borne diseases affecting human and animal health. These results are relevant for implementation of anti-tick Subolesin-based vaccines in Uganda and other countries in Sub-Saharan Africa., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined., Methods: Cost analyses of PH-ECPR was performed utilizing current PH-ECPR trial, NSW Ambulance Cardiac Arrest Registry (CAR), geospatial modelling and in-hospital costings data. Markov modelling was completed to combine the PH-ECPR cost analysis with reported patient outcomes across multiple ECPR strategies. Bridging formulae from ECPR survivor cerebral performance category (CPC) scores were used to estimate cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs). Probabilistic Sensitivity Analysis was completed to assess the probability of cost effectiveness for base case and PH-ECPR strategy variations., Results: Assuming a base case of 100 patients per year, with a 25% team allocation to ECPR, the average pre-hospital ECPR cost per patient was $12,741 and total of $88,656 AUD equating to approximately $44,000 per QALY. Addition of a conservative 10% kidney organ donation rate reduces the cost per QALY to $22,000. Patient survival rate, the proportion of time the pre-hospital ECPR team are allocated to ECPR and organ donation significantly impact PH-ECPR cost effectiveness., Conclusion: Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Background: Highly effective CFTR modulators improve CFTR function and lead to dramatic improvements in health outcomes in many people with cystic fibrosis (pwCF). The relationship between measures of CFTR function, such as sweat chloride concentration, and clinical outcomes in pwCF treated with CFTR modulators is poorly defined. We conducted analyses to better understand the relationships between sweat chloride and CFTR function in vitro, and between sweat chloride and clinical outcomes following CFTR modulator treatment., Methods: Mean sweat chloride values in healthy people, CF carriers, and pwCF treated with CFTR modulators at different doses were compared to chloride transport in corresponding human bronchial epithelial (HBE) cells. A pooled analysis of phase 3 CFTR modulator studies was performed to evaluate the relationship between attained values of sweat chloride and improvements in lung function, body mass index (BMI), patient reported outcomes, pulmonary exacerbations, and lung function change over time., Results: Sweat chloride concentrations in vivo correlated strongly with CFTR-dependent chloride current in HBE cells in vitro. Sweat chloride values of <30 mmol/L and ≥30 to <60 mmol/L in pwCF following CFTR modulator treatment were associated with better clinical outcomes than sweat chloride ≥60 to <80 mmol/L and ≥80 mmol/L., Conclusions: In pwCF treated with CFTR modulators, lower sweat chloride levels (reflecting greater CFTR function) are associated with better clinical outcomes. These results support the therapeutic strategy of further restoring CFTR function towards normal, as reflected in lowering sweat chloride to below the diagnostic threshold for CF (<60 mmol/L) and to normal (<30 mmol/L), with CFTR modulators., Competing Interests: Declaration of competing interest EZ reports grants and personal consulting fees from the Cystic Fibrosis Foundation and Vertex Pharmaceuticals (Vertex). BM reports grants from Vertex, Cystic Medicines, and Sionna Therapeutics, and serves on an advisory board for Vertex. DS reports honoraria from Vertex for an educational event and she is president of the Polish Cystic Fibrosis Society. EM reports grants and lecture honoraria from Vertex, and advisory board participation with Vertex, Janssen, Insmed, and CF Storm. IF reports grants from AbbVie, Bayer, Boehringer Ingelheim, Insmed, GSK, Vertex, and Zambon, consulting fees from AbbVie, Boehringer Ingelheim, Kither Biotech, and Vertex, and a leadership role with the European Cystic Fibrosis Society. JT-C reports institutional grants for research trial conduct from Vertex, Eloxx and 4DMT; personal consulting fees from Vertex, Insmed, and 4DMT; personal speaker fees from Vertex; personal fees for chairing DMC for AbbVie; leadership or committee roles in CFF, ATS, JCF, Emily's Entourage, and NIH. MM reports personal consulting fees from Abbvie, Antabio, Arrowhead, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, Prieris, Recode, Santhera, Splisense, and Vertex, honoraria for lectures from Vertex, and participation in advisory boards from Abbvie, Antabio, Arrowhead, Boehringer Ingelheim, Enterprise Therapeutics, Kither Biotec, and Pari. MK reports personal consulting fees from AbbVie, AzurRx, Cystetic Medicines, EnBiotix, First Wave Biopharma, Insmed, Laurent Pharmaceuticals, Mylan, and PBM BC Holdings; board participation for AbbVie, CFF, First Wave Biopharma, Insmed, Laurent Pharmaceuticals, Sionna, and Vertex; and committee membership for the Cystic Fibrosis Foundation. NN, JZ, EA-S, FVG, LM, VP-C, PS, CB, and DW are employees of Vertex and own stock or stock options in the company. NM-HD reports consulting fees from Enterprise Therapeutics and received honoraria for NIH data safety monitoring board participation., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). There is a need to characterize the cardiovascular health profiles of PLWH to appropriately guide primary prevention efforts, particularly in settings like Sub-Saharan Africa, where there is a high burden of HIV and limited resources. A cross-sectional analysis was conducted on a cohort of newly diagnosed PLWH and HIV-uninfected adults recruited from three HIV clinics in Mwanza, Tanzania. Modified Life's Simple 7 definitions were applied to the cohort to compare cardiovascular health profiles between the two study groups using Poisson regressions. Pooled cohort equation (PCE) scores were also calculated to compare the distribution of CVD risk between the two groups. Our study included 995 study participants (492 PLWH, 503 HIV-uninfected). PLWH had a higher prevalence of ideal body mass index (75%), ideal blood pressure (56%), and ideal total cholesterol but a lower prevalence of ideal smoking (84%) and ideal physical activity (39%) than HIV-uninfected counterparts. PCE scores were low throughout the study population (76.5%), regardless of HIV status. Primary prevention of CVD in newly diagnosed people living with HIV in Africa may need to focus on smoking cessation and optimization of physical activity levels.

Background: Despite early treatment of rheumatoid arthritis (RA) being well established to prevent erosive joint damage, studies report persistent moderate to high disease activity. Other pathologies, for example, rheumatoid vasculitis (RV) may contribute symptoms that may not be captured by existing clinical assessment., Objectives: To investigate ultrasound-observed changes in the proximal dorsalis pedis artery (DPA) between early (≤ 5 y) and established (>5 y) RA and the RA Disease Activity Index-5 (RADAI-5)., Methods: Participants with early (n = 20) and established RA (n = 20) were recruited. Five parameters of the DPA were examined with a previously established ultrasound method. Independent t-tests and Cohen d statistics assessed differences and effect size between ultrasound parameters and RADAI-5, and the two groups. Pearson correlation assessed associations between ultrasound parameters and RADAI-5., Results: Majority of participants (98%) demonstrated arterial wall thickening regardless of disease duration. However, lumen diameter (Cohen's d = 0.972, p = 0.004) and artery diameter (Cohen's d = 0.694, p = 0.034) were decreased in established RA compared to early RA. No strong associations were found between RADAI-5 and ultrasound parameters, except for lumen diameter in early RA demonstrating a fair association to RADAI-5 (r = 0.445). The mean RADAI-5 score indicated moderate to high disease activity with no difference between early and established RA (p = 0.283)., Conclusion: Arterial wall thickening of the DPA indicating the precursory changes of RV was observed in most RA participants, with reductions in artery and lumen diameter occurring in established disease. However, the long-standing instrument RADAI-5 may not reflect symptoms and clinical impacts related to vascular changes among people with RA., Competing Interests: Conflict of interest No conflict to report., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status., Objectives: To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda., Methodology: Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood., Results: Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively., Conclusion: There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

During the COVID-19 pandemic lockdown, we deployed a rapid, mobile phone-based survey to assess access and participation rates when using mobile phones to collect data on COVID-19 in Rakai, south-central Uganda. We sampled prior Rakai Community Cohort Study (RCCS) participants based on HIV status using mobile phone contacts. We administered a 30-minute phone-based interview to consenting participants to assess their knowledge about different aspects of COVID-19 and their access to care. Our analysis compares the mobile phone survey participation rates with historic participation rates in regular RCCS face-to-face interviews. We supplemented phone survey data with demographic, behavioral, and HIV status data from prior face-to-face RCCS surveys. Phone access in Round 19 of the RCCS was found to be 90.2%, with lower access among older people, and people living with HIV. When including only individuals who participated in the previous RCCS survey round, participation in the face-to-face survey (81.9%) was higher than participation in our phone survey (74.8%, p  < .001). Survey participation was higher among people living with HIV compared to HIV-negative individuals (84.0% vs 81.4%, p  < .001) in the face-to-face survey, but in the phone survey the reverse was found, with participation rates being higher among HIV-negative individuals compared to people living with HIV (78.0% vs 71.6%, p  < .001). It was possible to collect data from an existing population cohort during the lockdown using phones. Phone access was high. Overall participation rates were somewhat lower in the phone survey, notably in people living with HIV, compared to the face-to-face survey.

To continue working during menses, female sex workers (FSW) may use unhygienic absorbents to hide their menstrual status. The menstrual disc may provide a solution. Little is known about men's knowledge and views, specifically around sex during menstruation with FSW, a population who are particularly vulnerable to violence which may be heightened during menses. To identify constructs for successful and safe menstrual disc implementation we sought to identify knowledge and attitudes towards menstruation among male clients of FSW, including views on FSW menstrual disc use during intercourse. We conducted six focus group discussions comprising a total of 51 male clients of FSW, in Kisumu, Kenya, exploring their perceptions of menses and sex during menses. In preparation for future implementation of a menstrual disc intervention, we introduced the disc to participants with an information session, answering their questions and gathering their opinions on it. Thematic analysis found most clients had limited or inaccurate knowledge about menstruation, viewing blood and the menstruator, as dirty or unclean. Sources of knowledge included school, female relatives/partners, community or church. Those reporting formal education described the biological processes more accurately, while church education lent towards stigmatized perceptions. Most participants expressed negative views towards sex during menses (i.e., unpleasurable, forbidden or risky), usually stemming from misconceptions, and reported seeking FSW services because their wife / girlfriend was menstruating. Many felt deceived if a FSW was menstruating, were often aware of materials placed vaginally to absorb blood, but generally continued with the service. No clients had prior knowledge of the menstrual disc but accepted it as a safe, hygienic, and cost-effective alternative, with some voicing interest to purchase for their wife / girlfriend. We conclude there is a need to provide accurate information on menstruation to boys and men including in school curricula and faith teaching to address lack of knowledge and negativity. These findings suggest potential for adoption of menstrual discs by FSW with minimal adverse client reaction, and highlight possible partner support for women considering adopting a menstrual disc., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Osire et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Appropriate language use is essential to ensure inclusion of diverse populations in research. We aimed to identify possible language-related barriers regarding the informed consent process and propose interventions to improve clarity and understanding of pregnant and breastfeeding women participating in research., Methods: A cross-sectional qualitative study employing focus group discussions (FGD) was conducted in Uganda from August 2023 to September 2023, involving a diverse group of stakeholders from the community, including community members, research participants, and Community Advisory Board members. 19 FGD comprised adult participants representing at least six different mother tongues (Luganda, Acholi, Runyankole, Runyoro, Lugbara and English). An inductive thematic approach was utilized for data analysis using NVivo version 12 software to identify language factors that influence informed consent. A series of community validation workshops ensured concurrence., Results: At the individual level, language barriers, and low levels of literacy contributed to poor comprehension, thus hindering ability to achieve genuine informed consent. At the health facility level, participants reported that there was use of inappropriate, unclear language including inaccurate translations, with poor and complicated grammar in some consent forms. Participants reported that complex medical terminologies are difficult to translate to local languages. Community members highlighted that social/cultural norms in language use affected cultural perceptions of informed consent. To enhance understanding for individuals without education in science, participants suggested simplification of terminologies and avoidance of complex medical jargon. Researchers should identify participants' preferred languages and communicate in those languages whenever possible. If researchers are not fluent, trained interpreters should be identified. Informed consent documents must be translated into local languages to ensure participants comprehend the study's purpose, procedures, risks, and benefits. Involving community members during development and translation of these documents can provide valuable insights into local dialects and culturally specific concepts, ensuring that study tools like surveys and consent forms are accurate and respectful., Conclusion: Language barriers influence the informed consent process within communities in Uganda. These can potentially be resolved at individual, health system and community levels. Consideration of locally understandable terms in community-facing study documentation is likely to enhance understanding and could improve research participation, although further studies are needed to assess these. The use of appropriate language ensures that informed consent is genuine in keeping with principles of Good Clinical Practice, and developing a research communication strategy should be part of inclusive research design., Competing Interests: Declarations. Ethics approval and consent to participate: We obtained expedited ethical clearance for this study from the institutional review board (IRB) of the Infectious Diseases Institute (IDI- REC- 2023- 37) Uganda National Council of Science and Technology (HS2890ES). Also, approval was sought from the district health team and study participants. Written informed consent was sought, and only those who consented participated in the study. The research team ensured the utmost confidentiality during the entire process of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Giraffe (Giraffa spp.) are among the most unique extant mammals in terms of anatomy, phylogeny, and ecology. However, aspects of their evolution, ontogeny, and taxonomy are unresolved, retaining lingering questions that are pivotal for their conservation. We assembled the largest known dataset of Giraffa skulls (n = 515) to investigate patterns of cranial variability using 3D geometric morphometrics. The results show distinct sexual dimorphism and divergent ontogenetic trajectories of skull shape for the north clade (G. camelopardalis antiquorum, G. c. camelopardalis, G. c. peralta, and G. reticulata) and the south clade (G. giraffa angolensis, G. g. giraffa, G. tippelskirchi tippelskirchi, and G. t. thornicrofti) which was further supported statistically. Discriminant functions found statistically significant cranial shape differences between all four Giraffa species, and in some cases also between subspecies of the same species. Our 3D morphometric analysis shows that the four genetically distinct Giraffa spp. also have distinct cranial morphologies, largely addressable to features of display (ossicones). Our results highlight the importance of focusing future giraffe conservation efforts on each taxon to maintain their unique characteristics and biodiversity in the wild., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kargopoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The safe timing window for surgery during the acute phase of inflammation due to traumatic brain injury (TBI) has not been studied extensively. We aimed to elucidate the relationship between the timing of surgery and changes in perioperative serum levels of inflammatory cytokines and factors associated to optimize TBI management in low-middle-income countries., Methods: A prospective cohort study was conducted among TBI Patients with depressed skull fractures with a GCS > 8 operated at different timing from injury and followed up peri-operatively. We collected the clinical-radiological data, as well as pre-and postoperative venous samples from participants; we then did Luminex Assay to quantify the serum levels of pro/anti-inflammatory cytokines using the kits of 96-well human cytokine "27-Plex-Assay (#M500KCAF0Y®)." We performed the analysis with STATA version 17 and R&#95;studio applying both descriptive and inferential methods., Results: We enrolled 82 TBI patients with a median (IQR) age of 25.5 (20-34) years, and the majority were male (85.4%). There were 48.8% victims of assaults, and 73.2% had a post-resuscitation admission GCS of 14-15. There were 38 (46.3%) who were operated within 48 h of injury versus 44 (53.7%) after 48 h. Serum levels of TNF- α were significantly higher after surgeries done >48 h compared to those done ≤48 h ( p  = 0.0327); whereas, the difference in post-operative mean serum levels of IL-10 was significantly increased in patients who developed later SSI compared to those who did not (11.56 versus -0.58 pg./mL, p  = 0.0489). In multivariate analysis, the history of post-traumatic seizure (PTS) was associated with a postoperative increase in TNF- α ( p  = 0.01), the hemoglobin of 10-12 with a postoperative decrease of IL-4 ( p  = 0.05); the presence of focal neurological deficit was associated with a significant postoperative increased of TNF-α, IL-6, and IL-4 ( p  = 0.05). The presence of extra-axial hemorrhage was associated with a postoperative increase of IL-10 ( p  = 0.05)., Conclusion: Delayed surgical intervention beyond 48 h post-injury in mild-moderate TBI patients results in a significantly increased postoperative inflammatory response, as evidenced by elevated serum levels of TNF- α and IL-6. Neurological deficits, PTS, reduced hemoglobin rate, and extra-axial intracranial hemorrhage are factors associated with this heightened response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lekuya, Cose, Nakibuule, Ahimbisibwe, Fuller, Kamabu, Biryabarema, Olweny, Kateete, Kirabira, Makumbi, Vandersteene, Baert, Galukande and Kalala.)