Nakaseke Hospital

ABSTRACTObjective To identify modifiable intensive care unit factors associated with outcomes among patients receiving invasive mechanical ventilation in a low-income setting.Methods This prospective, multicenter, registry-embedded observational study has two components: a prospective registry-based cohort assessing patient- and care-process-related factors and a cross-sectional intensive care unit survey evaluating organizational structure. Functional intensive care units in Uganda will be included. Patients aged ≥ 15 years old requiring invasive mechanical ventilation will be enrolled. Patients extubated within 48 hours, transferred after > 24 hours, and imminent early death will be excluded. Primary outcomes will include 28-day intensive care unit mortality, intensive care unit length of stay, and mechanical ventilation duration. Tracheostomy-related outcomes will be explored in a pre-planned sub-study. Factors potentially associated with outcomes will be categorized into non-modifiable and potentially modifiable factors. Non-modifiable factors will include patient-related factors like age, comorbidities, and illness severity; potentially modifiable factors include processes of care (e.g., sedation levels) and intensive care unit organizational structure (e.g., staffing patterns). Multilevel multivariable logistic regression models will assess association outcomes. Survival analysis (Kaplan-Meier curves) will explore mortality trends. Confounders will be identified using directed acyclic graphs.Results (anticipated findings) This study will generate high-quality data on modifiable intensive care unit factors associated with ventilated patient outcomes in low-resource settings.Conclusion This is Uganda’s first registry-embedded, multicenter intensive care unit study to systematically potentially modifiable factors associated with ventilated patient outcomes. This study will provide evidence-based insights to optimize critical care management in low- and middle-income countries by leveraging real-time intensive care unit registry data.

BackgroundThe COVID-19 pandemic disrupted daily life, economies, and health, prompting strict government measures, including nationwide lockdowns and school closures in Uganda, resulting in significant academic setbacks for adolescents. The coping strategies employed by school-going adolescents in Uganda amidst the COVID-19 pandemic remain inadequately understood. This study aimed to assess the coping strategies adopted by school-going adolescents (early, middle and late adolescents) in the Manafwa watershed, recognized as one of Uganda’s most vulnerable regions, during the COVID-19 pandemic.MethodsA cross sectional study design was conducted from I5th May, 2023 to 30th June, 2023 on 762 school going adolescents from government-aided secondary schools within the Manafwa watershed area. The adolescent version of the KidCope tool was used to evaluate adolescents’ coping strategies. Factor analysis identified correlations among adolescents’ coping strategies. Independent Samples t-Test and One-Way Variance of Analysis (ANOVA) was used for comparing the mean score differences of the coping strategies among the gender and adolescents’ stages respectively.ResultsMajority (n = 141, 36.2%) of the participants employed adaptive coping followed by negative-emotion coping (n = 127, 32.6%) and avoidant coping (n = 122, 31.3%). Females employed statistically higher resignation as a coping strategy compared to males, (mean of 1.2 vs. 1.0, respectively; P = 0.026). A higher proportion (n = 88, 69.3%) of middle age adolescents employed negative-emotion regulation (P-value = 0.040). However, those in early adolescence significantly utilized distraction as a coping strategy more than those in middle adolescence (mean difference = 0.36, p = 0.013).ConclusionDuring the pandemic, majority of school-going adolescents employed adaptive coping mechanisms, including positive emotional regulation and social support. However, compared to males, females employed resignation more frequently. Moreover, middle-aged adolescents had a greater propensity for negative emotion copying. Findings from this study contribute valuable information for the development of targeted interventions and support mechanisms for adolescents facing unprecedented challenges.

We evaluated the effectiveness of radiotherapy combined with high-power hyperthermia with a radiofrequency output over 1500W for 13 patients with nonsmall cell lung cancer. An average total dose of 59.8 Gy by the conventional method, and an average of 12 sessions of hyperthermia during radiotherapy were employed. In addition, an average of 15 sessions of hyperthermia was administered after completing the radiotherapy. Complete response (CR, 100% regression) was achieved in 10/13 (77%) patients and partial response (PR, over 50% regression) in 3/13 (33%) for an overall response rate of 100%. Radiotherapy combined with high-power hyperthermia is especially advantageous for young patients with a thin subcutaneous fatty layer of the chest wall.

We have determined alpha-tocopherol (TOC) levels of red blood cell (RBC), serum and high density lipoprotein (HDL) by high performance liquid chromatography (HPLC) method in 10 uremics and in 10 age-matched normal controls. All subjects were male.TOC levels of RBC, serum and HDL were significantly reduced in uremics, particularly hemodialysis patients, than in controls.In the control group, there was a positive correlation of RBC to HDL and HDL/serum-HDL (non HDL) ratio while a negative relationship between RBC and non HDL was observed. On the other hand, the uremic group had only a negative relationship between RBC and HDL.The results in this study demonstrated that low RBC-TOC levels in uremics may be due to an impairment of TOC transfer from HDL to RBC.

Heparin-Sepharose affinity chromatography was employed to separate serum very low density lipoprotein (VLDL) into their subclasses both in hemodialysis patients and in age or sex-mathed controls. The VLDL obtained by sequential ultracentrifugation below density 1.006g/ml and dialysed against 2mM sodium phosphate buffer containing 0.05M NaCl, pH 7.4 was applied to Heparin-Sepharose column (1.5×20cm) equibrated with 2mM sodium phosphate buffer containing 0.05M NaCl, pH 7.4, and eluted stepwise at 0.05, 0.15 and 1M NaCl. The procedure of apolipoprotein (apo) VLDL delipidated was identical exept that the buffer contained 6M urea and the elution was performed at 0.05 and 0.5M NaCl.The VLDL sufractions were used for chemical determinations, 10% polyacrylamide-gel electrophoresis in 0.1% sodium dodecyl sulfate (SDS-PAGE) and Biogel A-15m column chromatography.The unbound fraction at 0.05M NaCl in both VLDL and apo VLDL of hemodialysis patients was much larger than those of controls. On the other hand, the bound fraction at 0.15M NaCl was similar between two groups. These lipoprotein fractions differed in their chemical compositions, the bound fraction at 1M NaCl in the patients containing more protein and less triglyceride than that in controls. The heterogeneity of the VLDL in hemodialysis patients were comfirmed by the fact that on gelfiltration the bound fraction at 0.15 and 1M NaCl of the patients were eluted slower than those of controls although the unbound fraction at 0.05M NaCl in both groups showed similar elution patterns. In SDS-PAGE, the bound fractions contained apprecicable amounts of apo E in both groups.These results indicate that VLDL from hemodialysis patients shows the low affinity to heparin, probably depending upon low concentrations of apo E.