Factors Influencing the Health-Related Quality of Life Among Lower Limb Amputees: A Two-Center Cross-Sectional Study.

Background: Limb amputation is among the commonly performed surgical procedures known to have a significant impact on health-related quality of life (HRQoL). Nonetheless, factors influencing the HRQoL among amputees have not been extensively explored. We therefore conducted a study aiming at determining factors influencing the HRQoL among lower limb amputees. Methods: A cross-sectional study was conducted from May 2021 to December 2021 in two specialized hospitals located in Dar es Salaam, Tanzania. A total of 160 participants who exclusively underwent lower limb amputation(s) were recruited. Data was collected using a checklist incorporating the 36-Item Short Form Survey (SF-36) questionnaire. Multivariable linear regression analysis was performed to identify factors influencing the HRQoL. Results: The mean age of the study participants was 53.8 (±15.44) years; with males constituting 68.7%. The mean duration since amputation was 19.84 (±12.44) months. A relatively poor physical component summary score (PCS), as opposed to the mental component summary score (MCS) of the SF-36 was observed among the participants (42.0 vs. 59.3, respectively). Factors that positively influenced the PCS included achieving a college/university level of education, absence of stump pain, and the use of a prosthetic device or crutches. Conversely, factors that negatively influenced the PCS included increasing age and the absence of associated comorbid conditions. These factors accounted for 34.1% of the variance in the PCS. With reference to the MCS, post-amputation employment, longer durations since amputation, and the use of prostheses or crutches had a positive influence. However, having no associated comorbidity negatively influenced the MCS. These factors explained 26.5% of the variances in the MCS. Conclusion and Recommendations: The aforementioned factors should be addressed accordingly in order to ensure a holistic approach in the management of lower limb amputees. Moreover, longitudinal studies are recommended to systematically study the change in HRQoL over time and to assess its determinants.

Surgical Apgar Score can accurately predict the severity of post-operative complications following emergency laparotomy.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: This study has demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital.

Successful open surgery repair of isolated right diaphragmatic rupture in 1-year-old patient at Muhimbili National Hospital: a case report and literature review.

Diaphragmatic ruptures rarely occur in isolation, a pathology in paediatric that is difficult to diagnose and can lead to serious complications if left untreated. We present a rare case of isolated right diaphragmatic rupture with liver herniation that was successfully repaired, along with a literature review. A 1-year-old female child was admitted at Emergency Department after being involved in a motor traffic crash as a passenger. Based on clinical presentation and radiological findings, we diagnosed a diaphragmatic rapture, laparotomy was performed in which we found a right isolated diaphragmatic rupture, which was repaired primarily. After re-evaluations, the patient was discharged day 16 postoperative. It is essentially important to evaluate the level of organ damage thoroughly for making a timely informed decision in management paediatric chest trauma.