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.

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.

Gastrointestinal malignancies constitute the most common neoplasms with increasing prevalence worldwide, which portend a dismal morbidity and higher mortality rate. Epigenetic phenotypes and field cancerization impute a cutting edge for precursor of several gastrointestinal malignancies; this genetic aberration has been implicated in tumorigenesis and recurrence of gastrointestinal malignancies. This systematic review aims at assessing the effect of epigenetics and field cancerization on carcinogenesis and recurrence of gastrointestinal malignancies. This systematic review and meta-analysis will administer the provisions of Preferred Reporting Items for Systematic Review and Meta-analysis 2020 guideline, and the review protocol has been registered at PROSPERO. The literature search will be executed through several electronic databases including EMBASE, PubMed, Scopus, Web of Science, Cochrane, Global Index Medicus, Semantic Scholar and Google Scholar. All original research articles reporting on the effect of epigenetic signatures, epigenetics and field cancerization on the carcinogenesis and recurrence of gastrointestinal cancers in adults will be included. Only articles with Newcastle–Ottawa Scale score above 4 and low risk of bias based on D1–D5 for randomized controlled trials will be included for a meta-analysis. There is no involvement of human subject participation in this review, thus giving no effect to ethical clearance approval. The evidence report of this review will be disseminated on scientific conferences and will be published to a reputable journal of gastroenterology oncology. This review has been registered at PROSPERO registry ID CRD 42023391339.

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.

Glioblastoma (GBM) is one of the most aggressive central nervous system tumours with suboptimal treatment options and associated poor prognosis. A major impediment to systemic treatment is the limitation of drug delivery to the tumour by the blood-brain barrier (BBB). Several novel techniques to permeate the BBB have been described, however of significant promise is the disruption of the blood brain barrier with low-intensity pulsed ultrasound (LIPU) to facilitate the delivery of varying therapeutic agents. This emerging technique has been demonstrated in clinical studies to enhance delivery of chemotherapeutic agents to the tumour. This study protocol seeks to guide the comprehensive review of literature concerning the safety and utility of LIPU for effective BBB penetration in the treatment of GBM. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) guideline 2020. The search strategy was performed on four databases: PubMed, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials. All observational and human randomised controlled studies describing the use of LIPU in the treatment of GBM will be included. Excluded studies include non-human randomized control trials, abstract only articles, letters to the editor, conference proceedings. Our outcomes include frequency of LIPU used, duration of intervention, clinical outcomes, complications, and challenges associated with the use of LIPU. This study aims to assess the safety and feasibility of this technique in the management of the GBM and proscribe its use if found effective to improve the outcomes in these patients.

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.