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BackgroundIntra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients.MethodsThis was a cross sectional descriptive study involving surgical patients in critical care units at KNH, carried out from March 2015 to October 2015.One hundred and thirteen critically ill and ventilated patients 13 years or older were recruited into the study.Krohn’s intravesical method was used to measure intra- abdominal pressure (IAP). Measurements were done at first contact, then at 12 and 24 h. Additional parameters recorded included: laboratory tests such as serum bilirubin and total blood count as well as clinical parameters such as urine output, vital signs and peak airway pressure, among others.Frequency, means and standard deviation were used to describe the data. Categorical variables e.g. age, were analysed using Chi square test and continous variables using student ‘t’ test and Mann Whitney test as appropriateResultA total of 113 consecutive surgical patients admitted to the critical care units were recruited. Of our study population, 71.7% (by IAP max) and 67.3% (by IAP mean) had IAH. Abdominal compartment syndrome (ACS) developed in 4.4% of the population. The following factors were significant determinants of risk of IAH : amount of IV fluids over 24 h (3949.6 vs 2931.1, p = 0.003, adjusted OR 1.0 [1.0-1.002]), haemoglobin values at admission (9.9 vs 12.0, p = <0.012, adjusted OR 0.6 [0.4-0.9]), peak airway pressure (28.4 vs 17.3; p = 0.018, adjusted OR 1.6 [1.1-2.4]) and synchronised intermittent mandatory ventilation (SIMV) (60 vs 32; p = 0.041, adjusted OR 1.4 [0.78-2.04]).Of those who had IAH; age, amount of iv fluids over 24 h, fluid balance and ventilator mode were significant determinants of risk of progression to ACS .ConclusionThe prevalence of intraabdominal hypertension and abdominal compartment syndrome at KNH is high. Clinical parameters pertaining to fluids administration and ventilator mode are siginificant determinants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0120-y) contains supplementary material, which is available to authorized users.

Background: Breast reconstruction following mastectomy has mental and physical health benefits. Several patient-centered factors predict the rate of breast reconstructions. We investigated the rates and predictors of breast reconstruction in postmastectomy patients diagnosed with breast cancer at a teaching and national referral center. Methods: A retrospective case-control study involving post-mastectomy females diagnosed with breast cancer from 2014 to 2018. Logistic regression evaluated potential predictors of breast reconstruction. Results: 312 women had mastectomies during the 5-year study period: 9 (2.88%) had breast reconstructionall breast reconstructions were autologous (latissimus flap). The rate of reconstruction increased over the study period, then dropped in 2018. Factors significantly affecting the rate of breast reconstruction included patient age and insurance coverage. Conclusion: In this hospital-based study, the rate of post-mastectomy breast reconstruction is low, despite the procedure being an essential component of breast cancer care. Age and insurance coverage are predictors for breast reconstruction.

Adult testicular torsion is thought to be rare if not relatively unusual. The rarity could be an underestimation since there are many episodes of missed torsions and misdiagnosis with other conditions of acute scrotum despite the now widespread ultra sound availability that are being reported in the literature. Such a misdiagnosis is herein reported of a 41 year old man.

Background: The deleterious effects of intraabdominal hypertension and abdominal compartment syndrome, affect almost every system. Patients at risk are the critically ill, in whom it leads to altered organ perfusion and end organ dysfunction/failure. The five cases reported highlight the diagnostic and management challenges. Case Presentation: Five patients with variable degrees of multiple organ dysfunction/failure as evidenced by derangements in laboratory and clinical parameters are presented. Non-surgical interventions including insertion or repositioning of nasogastric tube, insertion of flatus tube, careful titration of IV fluid requirements and appropriate adjustments of ventilator setting were instituted. All five did not respond to initial management and decompressive