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Biomedical subjects

G I Muguti

Publications and source records attributed to G I Muguti.

At least 19 recordsLinked to original sources
PubMed1997

An analysis of the factors contributing to mortality rates in burns patients treated at Mpilo Central Hospital, Zimbabwe.

We present a retrospective analysis of 49 patients (61% males and 39% females) with burns who died at Mpilo Central Hospital between January 1990 and December 1993. Of the patients, 61% (30/49) were in the paediatric age group, with 55% (27/49) under 2 years of age. Most burns occurred at home (79%) and 17% of the burns occurred at the workplace. The commonest burning agents were hot water (39.5%) and open fires (39.5%). The surface area of burns ranged from 10 to 88% with a mean of 35%. Deep partial thickness and full thickness burns accounted for 52% of cases. All the patients required active resuscitation with intravenous fluids. A total of 35 organisms were isolated on 18 pus swabs. The most commonly isolated organisms were Staphylococcus aureus (43%) and Pseudomonas (23%). The main factors contributing to death were septicaemia (n = 15), pneumonia (n = 10) and acute renal failure (n = 7). The majority of patients (65%) died within 10 days, 61% of whom were children. The average time to death was 14 days (range 1-64 days). It is clear that some patients with severe burns will die regardless of how well they are managed. The key to successful management of those patients who should survive lies in early presentation and active resuscitation, prevention and control of infective complications and adequate nutritional support.

Adolescent↗
PubMed1997

Major vascular injury in civilian practice in Bulawayo, Zimbabwe.

OBJECTIVE: To assess the extent of the problem of major vascular injuries in our practice and also to analyse the causes and the results of our management of these injuries at Mpilo Central Hospital. DESIGN: A study of eight patients who were treated for major vascular injuries at Mpilo Central Hospital between 1989 and 1994. SETTING: Mpilo Central Hospital, Bulawayo, Zimbabwe. SUBJECTS: Eight patient who were treated for major vascular injuries. MAIN OUTCOME MEASURES: Causes of vascular injury, other injuries, haemodynamic state on admission, surgical procedures carried out, complications and outcome. RESULTS: All three major vascular injuries due to stab wounds were successfully repaired. Of the four patients with major vascular injuries due to complicated orthopaedic injuries, two had successful repair of the vascular injury but the other two underwent amputation. The eighth patient who sustained an arterial injury during the course of a difficult operation for a tumour on the left forearm had a successful repair of the vascular injury. CONCLUSION: This study has shown that stab wounds and complicated orthopaedic injuries are the main cause of major vascular injury in civilian practice in our community. The importance of adequate resuscitation, early diagnosis and early appropriate surgical intervention is emphasized.

Adolescent↗
PubMed1996

The outcome of surgical treatment of pressure sores at Mpilo Central Hospital, Zimbabwe.

OBJECTIVE: To analyze the results of surgical management of pressure sores at Mpilo Central Hospital and also to identify the characteristics of patients who develop pressure sores in our community. DESIGN: A retrospective study of 25 patients who were treated surgically for pressure sores at Mpilo Central Hospital between January 1991 and December 1994. SETTING: Mpilo Central Hospital, Bulawayo, Zimbabwe. SUBJECTS: Twenty five patients who under-went surgical treatment for pressure sores. MAIN OUTCOME MEASURES: Site of pressure sore, underlying cause of pressure sore, investigations, surgical procedures, complications, recurrence of pressure sores and length of hospital stay. RESULTS: The mean age of the patients was 35 years (standard deviation, SD 17). There were more patients with pressure sores from rural areas (n = 15) than from urban areas (n = 10). Most pressure sores occurred in the trochanteric region, 36pc (12/33), ischial region, 33pc (11/33) and in the sacral region, 21pc (7/33). The commonest condition predisposing to pressure sores was spinal cord trauma, 48pc (12/25). Most of the patients underwent excision and flap repair (58pc) and excision and direct closure of the pressure sore (35pc). The main post operative complication was wound infection which occurred in about half the cases (n = 12). The only death in this series occurred in one patient who developed a gram negative septicaemia. The mean hospital stay was 66 days (SD37). CONCLUSION: This study indicates that spinal cord trauma, 48pc (912/25), is the commonest condition predisposing to pressure sores in our community. The incidence of such injuries can be reduced by strict enforcement of Road Traffic Regulations and improving safety precautions at the work place. As shown in this study the use of suitable flaps reduces the recurrence rate of pressure sores.

Adult↗
PubMed1995

The sensate deep inferior epigastric musculocutaneous flap and the twelfth thoracic nerve.

A detailed anatomical study of the terminal branches of the twelfth thoracic nerve (subcostal nerve) based on observations made during dissections of 23 embalmed cadavers is presented. In all 23 cadavers, the twelfth thoracic nerve had an ascending branch which joined the deep inferior epigastric vascular pedicle about half way between the lower border of the umbilicus and the symphysis pubis. This observation, we believe, explains how it is possible to preserve sensation in the deep inferior epigastric musculocutaneous flap.

Adolescent↗
PubMed1995

Splenic and hepatic trauma: a three year review.

We present a three year study of 22 consecutive patients treated for splenic and liver injuries at Mpilo Central Hospital between 1988 and 1990. A total of eight patients died giving an overall mortality rate of 36 pc. There was no mortality recorded in nine patients (41 pc) treated for splenic injuries. However, of the nine patients (41 pc) treated for liver injuries four patients died giving a mortality rate of 44 pc in this group. The highest mortality rate was recorded in the group of patients with both splenic and liver injuries because these injuries were invariably associated with other severe multiple injuries. We admitted four patients (18 pc) in this group and they all died.

Adolescent↗
PubMed1995

Stab wounds in Bulawayo, Zimbabwe: a four year audit.

Between January 1989 and December 1992 a total of 102 patients (88 pc male and 12 pc female) were treated for stab wounds at Mpilo Central Hospital, Bulawayo, Zimbabwe. The case records of these patients have been studied retrospectively. The mean age of the patients was 30 years (Standard Deviation 9). Most of the patients, 82 pc (82/102) were residents of the city of Bulawayo with only 18 pc (18/102) coming from rural areas. The mean delay in presentation was 12 hours (SD 11). A knife was the stabbing instrument in most cases (82 pc). Fights, 38 pc (26/68), domestic disputes, 26 pc (18/68) and robbery 21 pc (14/68) were the commonest motives for stabbing. In most cases stabbing occurred in a beer hall, 47 pc (26/55) and at home, 31 pc (17/55). The majority of stab wounds occurred in the chest, 51 pc followed by the abdomen, 31 pc. Of the patients with stab wounds of the chest 22 pc (14/65) required intercostal chest drains. Of the 39 patients with stab wounds of the abdomen 20 patients were subjected to laparotomy. No abnormality was found at operation in 50 pc (10/20) of cases. No major complications or mortality were recorded in this series. Based on the findings in this study, there is need for us to adopt a more conservative approach to the management of stab wounds, especially those involving the abdomen. This policy of "selective conservatism" should be based on a thorough physical examination and appropriate special investigations. Active surgical intervention should be reserved for specific indications.

Adolescent↗
PubMed1994

A review of burns treated over a one-year period at Mpilo Central Hospital, Zimbabwe.

A retrospective study is presented of 297 patients (57% male and 43% female) treated for burns at Mpilo Central Hospital, Bulawayo, Zimbabwe in 1991. Of the patients, 73% were in the paediatric age group, 60% of whom were under 5 years of age. Most burns occurred at home (90%), with the majority occurring in the kitchen (61%). The commonest burning agent was hot water (55%). Open-fire burns accounted for 18% of cases. The surface area of burns ranged from 1% to 80% with a mean of 7%. The majority of patients (84%) had superficial thickness burns. Only 6% of the patients required active resuscitation with intravenous fluids. A total of 159 organisms were isolated on 111 pus swabs. The most commonly isolated organism was Staphylococcus aureus (66%). Seven patients (five children and two adults) died, giving a mortality rate of 2%. Although it is desirable to have a purpose-built burns unit this study shows that satisfactory results can be achieved with limited facilities. In our practice, where 90% of burns occur in the home situation, an active public-education campaign would help to reduce the incidence of burns.

Adolescent↗
PubMed1994

Umbilical hernia in Bulawayo: some observations from a hospital based study.

We present a retrospective study of 40 consecutive patients admitted with umbilical herniae to Mpilo Central Hospital between January 1990 and December 1993. The majority of the patients 95 pc (38/40) were children and only 5 pc (2/40) were adults. The study included 18 males and 22 females giving a M:F ratio of 1:1,2. In children the age range was from 1 month to 13 years with 63 pc (24/38) occurring in the zero to five year age group. The commonest indication for admission was obstruction of the umbilical hernia in 37.5 pc (15/40) of cases. Other indications included: large umbilical hernia 30 pc (12/40), recurrent discomfort and peri-umbilical pain 20 pc (8/40), incidental finding in patients admitted for some other problem 7.5 pc (3/40), one case of recurrent hernia and one case of accidental injury. Spontaneous reduction of obstructed umbilical herniae occurred in 86 pc (13/15) of cases and operative reduction was carried out in 14 pc (2/15) of cases. There was no mortality recorded in this series. It is clear from our findings in this study that obstruction of the umbilical hernia in children in our practice although relatively uncommon, is a well recognised surgical emergency. On the basis of our findings we would recommend that prophylactic umbilical hernia repair should be performed in all girls over two years of age and in all children over four years of age.

Adolescent↗
PubMed1994

Snake bites in Zimbabwe: a clinical study with emphasis on the need for antivenom.

A retrospective analysis of 83 consecutive patients (42 males and 41 females) treated for snake bites at Mpilo Central Hospital between January 1990 and June 1992 is presented. In Zimbabwe poisonous snakes belong to four families; Colubrids (Boomslang), Vipers (Puff Adder), Elapids (Mambas and Cobras) and Atractaspids (Bibron Stilleto snake). The Puff Adder is responsible for three quarters of the bites. Forty eight pc (40/83) of the patients were below 20 years of age (range 1 year 10 months to 72 years). Most bites occurred at night (61 pc) in the rainy season (November to April). The majority of snake bites occurred on the lower limb, 64 pc (53/83), with most of the remainder occurring on the upper limb, 34 pc (28/83). The most common clinical features were; pain (95 pc), swelling (87 pc), tachycardia (20 pc), fever (13 pc) and vomiting (8 pc). This study, carried out at a time when there was no antivenom in stock at Mpilo Hospital, shows a considerable mortality (5 pc, 4/83) and morbidity (37 pc, 31/83) rate from poisonous snake bites in Zimbabwe. These observations highlight the need to maintain adequate stocks of antivenom in the major hospitals in Zimbabwe.

Adolescent↗
PubMed1994

Torsion of the testis: review of clinical experience in Zimbabwe.

A detailed retrospective analysis of 90 patients with torsion of the testis managed at Mpilo Central Hospital between January 1987 and December 1991 is presented. The mean age of all patients was 17 years (range two months to 32 years). Sudden and severe scrotal pain was the commonest mode of presentation seen in 98 pc (88/90) of cases. Vomiting occurred in 30 pc (27/90) of cases and urinary symptoms were present in 5.5 pc (5/90) of cases. A history suggestive of previous episodes of torsion was obtained in 12 pc (11/90) of cases. Seventy one pc (64/90) of patients presented within 72 hours (mean delay 32 hours). Twenty nine pc presented late (i.e. after 72 hours) with a mean delay of seven days. The overall testicular salvage rate was 36 pc in this series. The only complications encountered were two minor wound infections which settled down on dressings and antibiotics. The successful management of a patient with torsion of the testis depends on; early consultation on the part of the patient, correct diagnosis by the doctor at first consultation and urgent surgical exploration of the affected testis.

Adolescent↗
PubMed1994

Some pitfalls in burns management: illustrative case reports with a discussion on ways to improve the outcome of treatment.

We present two females with severe, mainly full thickness burns, who have developed gross deformities due to inadequate treatment of their burns. Early referral to major centres with the technical expertise and material resources to manage such complicated injuries will help to minimise the degree of deformity and disability suffered by these patients. Adequate resuscitation, relatively early split skin grafting, intensive physiotherapy and appropriate splintage are the hallmark of treatment of such severe burns.

Adolescent↗
PubMed1994

Occupational burns as seen in a major industrial city in Zimbabwe.

A retrospective study of 22 male patients treated at Mpilo Central Hospital for occupational burns between January 1991 and December 1992 is presented. The mean age was 36 years (range 18-62 years). Forty five pc of the patients were general labourers and 55 pc were semi skilled workers. The commonest burning agent was open fire in 32 pc of cases. A wide variety of other burning agents was recorded. The surface area of burns ranged from one pc to 88 pc with a mean of 21 pc. Partial thickness and full thickness burns accounted for 48 pc of cases. Thirty two pc of cases required active resuscitation with intravenous fluids. The average duration of stay in hospital was 29 days (range 2-235 days). Three patients with severe burns died giving a mortality rate of 14 pc. As the city of Bulawayo becomes more industrialised the need for a purpose built burns unit to deal with these severe injuries warrants serious consideration. In the meantime attention should be focused on various aspects of burns prevention at the work place.

Accidents, Occupational↗
PubMed1993

Dupuytren's contracture in black Zimbabweans.

Four cases of Dupuytren's contracture treated at Mpilo Central Hospital over the last 13 years are presented. Three of these patients were men aged 45, 59 and 74 years. Only one woman aged 55 years was treated during this period. All the four patients were indigenous Black Zimbabweans. There was some history of trauma to the affected upper limb in all three of the male patients and all of them agreed to being moderate smokers but only two gave a history of drinking alcohol. One of the men had been treated for pulmonary tuberculosis. The female patient has been on treatment for epilepsy for more than 10 years. There was no family history of Dupuytren's contracture in any of these patients. Although Dupuytren's contracture is generally considered to be a European disease this report and a few isolated case reports confirm that this condition occurs in indigenous Black Africans.

Aged↗
PubMed1993

Experience with breast cancer in Zimbabwe.

Eighty-four patients were treated for carcinoma of the breast at Mpilo Central Hospital, Bulawayo, between July 1987 and December 1990. The age at diagnosis appears to be bimodal with an early peak between 35 years and 40 years and a later peak between 60 years and 65 years. As expected, these patients were of high parity (median 5) and 96% of them breast fed for an average of 16 months. It would appear that late presentation with advanced systemic disease accounts for the dismal prognosis. Eighty-four per cent of the patients presented with late disease with only 16% presenting with early disease. Of the 25 patients who were followed to death the median survival was 12 weeks. For various logistic reasons long-term follow-up has not been possible for the rest of the patients. The expense involved in travelling long distances appears to be the main problem. To improve the outcome of breast cancer in our community we we need to embark on an active education campaign to increase public awareness of the significance of breast symptomatology. However, the incidence of carcinoma of the breast in this part of the world remains very low when compared with experience in Western countries.

Adult↗