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4 results on '"Robert Mugarura"'

1. Esophageal foreign body retrieved by cervical esophagotomy four years after ingestion

Author

Felix Oyania, Robert Mugarura, Charles Newton odongo, Sarah Jane Commander, and Martin Situma

Subjects
Pediatrics, RJ1-570, Surgery, RD1-811
Abstract

Background: Foreign body ingestion is common pediatric population with more than 55% from ingestion of coins. Over 80% pass spontaneously through the digestive tract, but substantial amount lodge in the UES causing esophageal perforation. Failure to recognize and treat as an emergency can cause significant complications and mortality aggravated by longer duration of impaction. Impacted FB can be retrieved by endoscopy with over 95% success rate. In the event of failed endoscopic retrieval, surgery offers safe alternative. The latter usually indicated in perforation, stricture, esophago-aortic and trachea-esophageal fistulas. Clinical case: A 12-year old female patient with a coin impaction in the cervical esophagus for over four years managed for recurrent respiratory infection. Conclusion: Foreign body – coins ingestion is common in pediatric population. Timely recognition and treatment is required to prevent severe complications and mortality. Diagnosis involves a triad of clinical history, X-ray appearances and esophagoscopy.

Published
2023
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4. A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study

Author

Peter Nthumba, Nejla Zeynep Kubilay, Sean M. Berenholtz, Joseph Musowoya, Jack Barasa, Mayaba Maimbo, Benedetta Allegranzi, Gabriel Okumu, Alex Aiken, Robert Mugarura, Alex E. Elobu, Angèle Gayet-Ageron, and Josephat Jombwe

Subjects
0301 basic medicine, medicine.medical_specialty, Cross Infection/prevention & control, Infection Control/methods, 030106 microbiology, Logistic regression, Cohort Studies, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Risk Factors, Intervention (counseling), Health care, medicine, Infection control, Humans, Surgical Wound Infection, Cumulative incidence, 030212 general & internal medicine, ddc:613, Surgical Wound Infection/drug therapy/epidemiology/prevention & control, Cross Infection, Infection Control, Patient Safety/standards, business.industry, Perioperative, Hospitals, Anti-Bacterial Agents, Anti-Bacterial Agents/therapeutic use, Infectious Diseases, Africa/epidemiology, Emergency medicine, Africa, Patient Safety, business, Cohort study
Abstract

Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa.We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders.Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8·0% (95% CI 6·8-9·5; n=129) to 3·8% (3·0-4·8; n=70; p0·0001), and this decrease persisted in the sustainability period (3·9%, 2·8-5·4; n=35). A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods. The likelihood of SSI during follow-up was significantly lower than pre-intervention (odds ratio [OR] 0·40, 95% CI 0·29-0·54; p0·0001), but the likelihood of death was not significantly reduced (0·72, 0·42-1·24; p=0·2360).Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes.US Agency for Healthcare Research and Quality, WHO.

Published
2017

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