Clinical Medicine and Dentistry

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Acute care surgery in Rwanda: Operative epidemiology and geographic variations in access to care
(Elsevier Inc, 2015) Kyamanywa, Patrick
Background. Surgical management of emergent, life-threatening diseases is an important public health priority. The objectives of this study were to (1) describe acute care general surgery procedures performed at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease presentations and referral patterns. Methods. We performed a retrospective review of prospectively collected acute care surgery cases performed at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011. Using Pearson’s v 2 test and the Fisher exact test, we compared cases originating from within Kigali and transfers from other provinces. Geospatial analyses also were used to further describe transfer patterns. Results. During the study period, 2,758 surgical interventions were performed, of which 25.6% (707/ 2,758) were general surgery operations. Of these, 45.4% (321/707) met the definition of acute care surgery. Only about one-third---32.3% (92/285)---of patients resided within Kigali, whereas about twothirds--- 67.7% (193/285)---were transferred from other provinces. Most patients transferred from other provinces were younger than 18 years of age (40.4%; 78/193), and 83.0% (39/47) of patients older than 50 years of age originated from outside of Kigali. Specific operative indications and surgical procedures varied substantially between patients from Kigali and patients transferred from other provinces. Conclusion. Emergency surgical conditions remain important contributors to the global burden of disease, particularly in low- and middle-income countries. Geographic variations exist in terms of operative diagnoses and procedures, which implies a need for improved access to surgical care at the district level with defined transfer mechanisms to greater-level care facilities when needed.
Blood Group Distribution in a Study Population and their Associated Rhesus Factor (Uganda)
(Scholars Academic and Scientific Publisher, 2015) Mukinda, Frank Kamya; Lule, Herman; Kalange, Muhamudu; Echoru, Isaac; Ninsiima, Herbert Izo; Kasozi, Keneth Iceland
Whole blood transfusions have continuously been done in medical hospitals as the major line of emergency recovery on the African continent as a result of limited infrastructure despite of the fact that the general blood group status is poorly understood. The aim of the study was to determine the prevalent blood groups and their associated rhesus factor. This was a cross sectional study conducted for a period of two months at Kampala International University Teaching Hospital involving a total of 47 undergraduate students, blood was picked by pricking the index finger and placed on a white tile from which the antigens were added to it. The study revealed that majority (53.2%) of the population had blood group O with the greatest prevalence being in the male population and blood group B was the second prevalent blood group in this study. This would probably be due to the establishment of endemic stability with malaria infections in the community. This would be due to genetic selection thus favoring the proliferation of the B and O blood groups as they appear to offer a mutuality protective advantage against plasmodium parasites. The major associated Rhesus factor were of O+ (53.2%) and B+ (21.3%) which showed that there was a significant downward shift in the levels of the Rhesus antigen. Blood group O was the most prevalent probably due to its evolutionary advantage in the region. Phenotypic expression need to be investigated further for the development of a strong hematological team in various rural communities.
Can Focused Trauma Education Initiatives Reduce Mortality or Improve Resource Utilization in a Low-Resource Setting?
(2015-04) Kamanywa, Patrick
Background—Over 90 % of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Methods—Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October–November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using x2 and Fisher’s exact test. Results—A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3 %, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3–8 had the highest injury-related mortality, which significantly decreased from 58.5 % (n = 55) to 37.1 % (n = 23), (p = 0.009, OR 0.42, 95 % CI 0.22–0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3–5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. Conclusions—The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multifactorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.
Ring Worm Skin Infection in a Rural Community of Bushenyi (Uganda)
(British Microbiology Research Journal, 2015-06-15) Tsamiya, Suleiman Abubakar
Ring worm skin infections which have continuously been neglected in several communities of sub Saharan Africa, thus leading to the development of herbal remedies as communities seek to find solutions to the menace. The aim of this study was to assess the community skin ring worm infections and their associated risk factors in South Western Uganda. Materials and Methods: This was a cross sectional study in a rural community of Bushenyi district in South Western Uganda. A total of 34 homesteads were randomly selected and a semi-structured questionnaire was used for data collection. Results and Discussion: The study showed that majority of homesteads which accessed water from non protected springs, 41.2% had ring worm skin infection of the head (tinea capitis), 11.8% due to tinea corporis and 5.9% either due to tinea unguium, tinea cruris, tinea corporis, tinea circinata, or tinea glabrosa, tinea pedis and tinea barbae which are generalized in different parts of the body. The major risk factors identified were water security (P = 0.01) and community treatment practices (P = 0.002) against the dermatophytes. Despite the fact that some homesteads attempted to treat the skin infections, other homesteads didn’t bother to seek treatment thus posing a major risk factor for the re-infection in the community. Conclusion: The adoption of ethno-medicinal plants for management of skin infection has been shown to be greatly adopted by this rural community, thus a follow up study to understand the antifungal activity of a selected herbal plant from the community is highly encouraged.
Isolation and Antibiogram of Salmonella spp. from Quails in a Farm from Kelantan, Malaysia
(Journal of veterinary Advances, Global Researchers Journals, 2015-12-30) Bamaiyi, Pwaveno H.
Salmonellosis is a major public health problem around the world affecting both animals and humans. A study was carried out to elucidate the prevalence of Salmonella spp. and antibiogram of the isolates in quails in a commercial farm located in Kelantan, Malaysia using cloacal swabs and standard isolation techniques for Salmonella species and the standard disk diffusion method for the antibiotic sensitivity tests. Ninety quails in two groups of 45 each, aged 3 weeks and 2 months, were sampled using sterile cotton swabs and transport media. The results showed that the prevalence of Salmonella spp. in the quails was 11.11% (CI= 6.19, 19.28) and all the isolates were resistant to ampicillin. There was no significant difference (P>0.05) between the prevalence of Salmonella spp. in birds aged 3 weeks compared with the birds aged 2 months using Chi square at 95% confidence level. The positive identification of Salmonella spp. in quails may have public health implications due to the rising outbreak of Salmonella spp. associated food poisoning cases. The resistance of the Salmonella spp. to ampicillin which is a common antibiotic in man and animals adds weight to the growing call for the prudent use of antibiotics in human and animal populations around the globe. Farms and food handlers should maintain strict hygiene to protect public health at all times.
2015 Outbreak of Canine Rabies in Malaysia: Review, Analysis and Perspectives
(Journal of Veterinary Advances, 2015-12-30) Bamaiyi Pwaveno H.
Rabies is an acute fatal zoonotic encephalitis caused by a Lyssavirus belonging to the family rhabdoviridae responsible for about 69000 deaths annually. In July, 2015 Malaysia lost its rabies free status due to an outbreak of canine rabies that started from Perlis state and later moved to Kedah and Pulau Pinang states of Malaysia. This study was carried out to review available data on rabies and determine the incidence of rabies during the outbreak, the susceptible population of dogs, the number of dogs culled, the number of dogs vaccinated and lessons that can be learned from the outbreak using data principally from the OIE and other public domain sources. Statistical calculations employed chi square analysis at 95% confidence level using SPSS version 22. The incidence of rabies was 0.10% (CI= 0.05%, 0.18%). There was significant difference (P<0.0001) between the number of cases, number of susceptible dogs, number of dogs destroyed and number of dogs vaccinated between the 3 states in Malaysia with Perlis having the highest number of cases, Kedah having the highest number of susceptible dogs, Pulau Pinang having the highest number of culled dogs but with the least number of vaccinated dogs and Kedah having the highest number of vaccinated dogs. Perlis had the highest number of cases followed by Pulau Pinang. Kedah with the highest number of vaccinations recorded only 1 case of rabies. There was no case of human rabies despite numerous dog bite cases during the outbreak. The proximity of the 3 states especially Perlis to a rabies endemic country must have led to the outbreak of the infection. Mass vaccination of dogs along with short term targeted culling is important in stopping rabies outbreaks. Territories within close proximity to endemic locations must maintain more surveillance against transboundary diseases like rabies. Post exposure prophylaxis is necessary immediately after exposure to rabies to prevent human infection.
Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians
(International Journal of Health policy and management, 2016) Kyamanywa, Patrick
Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.
CREB Protein Expressed Differently in the Frontal Cortices of Datura stramonium Treated Rats: Implication for Addiction and Neurodegeneration
(Scientific Research Publishing, 2016-05) Ekanem, Peter E.; Sunday, Dare S.; Gaim, Kidanemariam
Background: cAMP response element-binding protein (CREB) is one of the cellular transcription factors found in neurons. CREB is also important for the survival of neurons, and has an important role in the development of drug addiction. Datura stramonium (DS) is a tropical ubiquitous plant commonly used to increase the intoxication of certain beverages for recreational purposes. The seeds of this plant are very toxic and may produce addiction on prolong usage. This research investigated the effects of administration of high doses of DS seeds on the expression of CREB protein in both male and female rats’ frontal cortices and its implication in addiction and neurodegeneration. Materials and Methods: The study was conducted with a total of 24 male and female Wistar rats weighing 200 g - 250 g. The rats were divided into three groups of 8 rats each. Each group was further divided into four sub-groups of 2 rats each. Ethanolic dried seed extract of DS was diluted in normal saline and administered intraperitoneally (i.p.) to the treatment groups. The treated sub-groups received 750 mg/kg of DS extract once in group 1, twice in group 2 and thrice in group 3 daily for 4 weeks respectively, while the control sub-groups received i.p. normal saline concurrently for the same duration of time. The rats were euthanized and an analysis of variance (ANOVA) was computed to detect a significant main difference of DS effect on CREB expression for each group, while post hoc Bonferroni Test compared CREB protein expression between male and female groups. Result: There were significant differences in the expression of CREB protein between the sub-groups and between the male and female rats of treated sub-group (p < 0.05) compared to the controls. There was a decrease in the female treated sub-groups and an increase in the male treated sub-groups compared to the respective controls. Conclusion: Highdoses of DS administration for a prolong time may affect the expressions of CREB protein differently in male and female treated rats which may consequently lead to addiction and neuro degeneration affecting frontal cortex neurons.
Laparoscopy in Rwanda: A National Assessment of Utilization, Demands, and Perceived Challenges
(Springer, 2018-09-19) Robertson, Faith; Mutabazi, Zeta; Kyamanywa, Patrick; Ntakiyiruta, Georges; Musafiri, Sanctus; Walker, Tim; Kayibanda, Emmanuel; Mukabatsinda, Constance; Scott, John; Costas-Chavarri, Ainhoa
Background Laparoscopy has proven to be feasible and effective at reducing surgical morbidity and mortality in low resource settings. In Rwanda, the demand for and perceived challenges to laparoscopy use remain unclear. Methods A mixed-methods study was performed at the four Rwandan national referral teaching hospitals. Retrospective logbook reviews (July 2014–June 2015) assessed procedure volume and staff involvement. Web-based surveys and semi-structured interviews investigated barriers to laparoscopy expansion. Results During the study period, 209 laparoscopic procedures were completed: 57 (27.3%) general surgery cases; 152 (72.7%) ob/gyn cases. The majority (58.9%, 125/209) occurred at the private hospital, which performed 82.6% of cholecystectomies laparoscopically (38/46). The three public hospitals, respectively, performed 25% (7/28), 15% (12/80), and 0% (denominator indeterminate) of cholecystectomies laparoscopically. Notably, the two hospitals with the highest laparoscopy volume relied on a single surgeon for more than 85% of cases. The four ob/gyn departments performed between 4 and 87 laparoscopic cases (mostly diagnostic). Survey respondents at all sites listed a dearth of trainers as the most significant barrier to performing laparoscopy (65.7%; 23/35). Other obstacles included limited access to training equipment and courses. Equipment and material costs, equipment functionality, and material supply were perceived as lesser barriers. Twenty-two interviews revealed widespread interest in laparoscopy, insufficient laparoscopy exposure, and a need for trainers. Conclusion While many studies identify cost as the most prohibitive barrier to laparoscopy utilization in low resource settings,logbook review and workforce perception indicate that a paucity of trainers is currently the greatest obstacle in Rwanda.
A narrative review on the basic and clinical aspects of the novel SARS-CoV-2, the etiologic agent of COVID-19
(Kampala International University, 2020-07) Joseph, Hokello; Adhikarimayum, Lakhikumar Sharma; Girish C., Shukla; Mudit, Tyagi
The novel SARS-CoV-2 is responsible for causing the ongoing outbreak of coronavirus disease 19 (COVID-19), a systemic infection in humans. Ever since it was first detected in December 2019, the number of confirmed cases has continued to increase. Within a short period, this disease has become a global issue, and therefore it is characterized as a pandemic. The current understanding and explanations are based on epidemiological, clinical and physiological observations. Besides, it remains a great challenge, as much remains to be understood about this new disease-causing virus. Therefore, we seek to provide an overview of SARS-CoV-2, including its classification, origin, genomic structure, replication cycle, transmission, pathogenesis, clinical aspects, diagnosis, treatments, prevention and vaccine options. We conducted a literature search for the articles published up to August 2020 using the keywords ‘SARCoV-2’ and ‘COVID19’ in medical databases; PubMed, google scholar, EMBASE, and web of science. Based on the information collected, the emerging COVID-19, caused by SARS-CoV-2, exhibits strong infectivity but less virulence in terms of severity of disease and mortality rates in certain age groups. It inflicts more damage in terms of peoples’ health and well-being, social life, and global economic impacts. Unfortunately, there is no adequate global and standard response to this pandemic to date, and each country is facing a crisis based on its situation, expertise, and hypotheses. While there is no effective therapy and vaccine against the novel SARS-CoV-2 yet, preventive measures are the only tool available to our disposal to control the spread of the COVID-19 pandemic. Ongoing and future research is focused more on developing standard t
Descriptive analysis of heavy metals content of beef from eastern Uganda and their safety for public consumption
(Kampala International University, 2021-02) Keneth, Iceland; Kasozi, Yunusu; Hamira, Gerald; Zirintunda, Khalaf F.; Alsharif, Farag M.A.; Altalbawy, Justine; Ekou, Andrew; Tamale, Kevin; Matama, Fred; Ssempijja, Robert; Muyinda, Francis; Kawooya, Pius; Theophilus, Hellen; Kisakye, Paul; Bogere, Henry; Matovu, Leonard; Omadang, Patrick; Etiang, Joseph; Mbogua, John Ochieng; Juma, Lawrence; Obado Osuwat, Regan; Mujinya, Gaber; El-Saber, Batiha; Ochan, Otim
In this study, we initiated an effort to generate information about beef safety in Uganda. Our entry point was to assess by atomic absorption spectrophotometry the levels of essential elements copper (Cu), cobalt (Co), iron (Fe) and zinc (Zn), and non-essential elements lead (Pb), chromium (Cr), nickel (Ni), and cadmium (Cd) in 40 beef samples collected from within and around Soroti (Uganda). The information was used to evaluate the safety of consuming such beef against the World Health Organization (WHO) limits. The latter was accomplished by (i) estimating the daily intake (EDI) of each metal in the study area, (ii) modeling the non-cancer health risk using the target hazard quotient (THQ) and (iii) modeling the cancer risk using the incremental lifetime cancer risk (ILCR). The study finds that the mean concentrations (±95% CI) and EDI were in the order of Fe > Zn > Cr > Ni > Pb > Co > Cu > Cd. Cancer risk was found to be due to Ni > Cr > Cd > Pb and significantly higher in children than adults. The latter particularly demonstrates the importance of Ni poisoning in the study area. Overall, while essential elements in our beef samples were below WHO limits (hence no health risks), non-essential elements had high health and cancer risks due to higher levels of Cr and N

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