A 32-weeks abdominal pregnancy with live foetus presenting as acute abdomen: A case report

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Peritonitis outcome prediction using mannheim peritonitis index at St.Francis Hospital Nsambya, Kampala - Uganda

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Causes and Patterns of Peritonitis at St. Francis Hospital Nsambya, Kampala - Uganda

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Evaluating compliance to Kenya national cancer guidelines on diagnosis and staging of breast cancer at Kenyatta national hospital

Background: In Kenya, breast cancer is one of the most prevalent diseases among women. Early diagnosis and stage-directed treatment are vital in reducing morbidity and mortality associated with it. The Kenya National Cancer Guidelines (KNCG) was developed in 2013. Utility of the guidelines is expected to improve early detection, timely diagnosis, harmonize and standardize treatment of cancer. This study sought to assess whether health care providers at Kenyatta National Hospital are utilizing the guidelines in diagnosis and staging of breast cancer.Study objective: To evaluate adherence to KNCG on diagnosis and staging of breast cancer.Study design: Retrospective descriptive study was conducted within five months. Study subjects: Two hundred and fifty (250) patients’ records with diagnosis of breast cancer between September 2013 and September 2015.Results: Most patients were female 95.6 % with mean age of 47.5±15.5 years. Duration from referral point to index breast clinic review was 10.9±11.1 days. Duration from index breast clinic review to surgery was 64.0 ±114.4 days. Documentation on findings from clinical assessment varied between 24.8 to 86.4%. Documentation on radiological assessment of the breast varied between 3.6 to 35.2% whereas for metastatic assessment varied between 3.6 to 64.0 %. Laboratory investigations documentation varied between 8.4 to 94.8% whereas pathologic diagnosis and tumour biology documentation varied between 3.6-62.4%. American joint cancer committee- tumour, node and metastasis (AJCC-TNM) staging was documented in 16 % of the records reviewed.Conclusion: From this study, triple assessment for breast cancer was incomplete and inconsistent which could result in negatively impacting management of these patients. Every effort should be put in place to track as well as prioritize patients with breast cancer in terms of investigations and surgical interventions in a timely manner. Clinical, radiologic and pathologic assessment must adhere to KNCG and be accurately documented. Clinician should undergo knowledge, attitude and practice (KAP) survey on KNCG so as to identify possible gaps and institute measures aimed at compliance which ultimately could improve care of patients with breast cancer at KNH

Entomological surveillance following a long-lasting insecticidal net universal coverage campaign in Midwestern Uganda.

BACKGROUND: A universal coverage campaign (UCC) with long-lasting insecticidal nets (LLINs) was implemented in four districts in Midwestern Uganda in 2009-2010. Entomological surveys were carried out to monitor changes in vector density, behaviour and malaria transmission following this intervention. METHODS: Anopheles mosquitoes were collected using CDC light traps quarterly and human landing catch twice a year in four sites. Collections were done at baseline before the campaign and over a three-year period following the campaign. Plasmodium falciparum circumsporozoite enzyme-linked immunosorbent assays were performed. A subset of anophelines were molecularly identified to species, and kdr L1014S frequencies were determined. RESULTS: The prevailing malaria vector in three sites was Anopheles gambiae s.l. (>97 %), with An. funestus s.l. being present in low numbers only. An. gambiae s.s. dominated (> 95 %) over An. arabiensis within A. gambiae s.l. In the remaining site, all three vector species were observed, although their relative densities varied among seasons and years. Vector densities were low in the year following the UCC but increased over time. Vector infectivity was 3.2 % at baseline and 1.8 % three years post-distribution (p = 0.001). The daily entomological inoculation rate (EIR) in 2012 varied between 0.0-0.98 for the different sites compared to a baseline EIR that was between 0.0-5.8 in 2009. There was no indication of a change in indoor feeding times, and both An. gambiae s.l. and An. funestus s.l. continued to feed primarily after midnight with vectors being active until the early morning. Kdr L1014S frequencies were already high at baseline (53-85 %) but increased significantly in all sites over time. CONCLUSIONS: The entomological surveys indicate that there was a reduction in transmission intensity coinciding with an increase in use of LLINs and other antimalarial interventions in areas of high malaria transmission. There was no change in feeding behaviour, and human-vector contact occurred indoors and primarily after midnight constantly throughout the study. Although the study was not designed to evaluate the effectiveness of the intervention compared to areas with no such intervention, the reduction in transmission occurred in an area with previously stable malaria, which seems to indicate a substantial contribution of the increased LLIN coverage

Ablation of AMP-Activated Protein Kinase α2 Activity Exacerbates Insulin Resistance Induced by High-Fat Feeding of Mice

OBJECTIVE—We determined whether muscle AMP-activated protein kinase (AMPK) has a role in the development of insulin resistance

Leptin Administration Favors Muscle Mass Accretion by Decreasing FoxO3a and Increasing PGC-1α in ob/ob Mice

Absence of leptin has been associated with reduced skeletal muscle mass in leptin-deficient ob/ob mice. The aim of our study was to examine the effect of leptin on the catabolic and anabolic pathways regulating muscle mass. Gastrocnemius, extensor digitorum longus and soleus muscle mass as well as fiber size were significantly lower in ob/ob mice compared to wild type littermates, being significantly increased by leptin administration (P<0.001). This effect was associated with an inactivation of the muscle atrophy-related transcription factor forkhead box class O3 (FoxO3a) (P<0.05), and with a decrease in the protein expression levels of the E3 ubiquitin-ligases muscle atrophy F-box (MAFbx) (P<0.05) and muscle RING finger 1 (MuRF1) (P<0.05). Moreover, leptin increased (P<0.01) protein expression levels of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), a regulator of muscle fiber type, and decreased (P<0.05) myostatin protein, a negative regulator of muscle growth. Leptin administration also activated (P<0.01) the regulators of cell cycle progression proliferating cell nuclear antigen (PCNA) and cyclin D1, and increased (P<0.01) myofibrillar protein troponin T. The present study provides evidence that leptin treatment may increase muscle mass of ob/ob mice by inhibiting myofibrillar protein degradation as well as enhancing muscle cell proliferation

Deficiency of the Mitochondrial Electron Transport Chain in Muscle Does Not Cause Insulin Resistance

It has been proposed that muscle insulin resistance in type 2 diabetes is due to a selective decrease in the components of the mitochondrial electron transport chain and results from accumulation of toxic products of incomplete fat oxidation. The purpose of the present study was to test this hypothesis.Rats were made severely iron deficient, by means of an iron-deficient diet. Iron deficiency results in decreases of the iron containing mitochondrial respiratory chain proteins without affecting the enzymes of the fatty acid oxidation pathway. Insulin resistance was induced by feeding iron-deficient and control rats a high fat diet. Skeletal muscle insulin resistance was evaluated by measuring glucose transport activity in soleus muscle strips. Mitochondrial proteins were measured by Western blot. Iron deficiency resulted in a decrease in expression of iron containing proteins of the mitochondrial respiratory chain in muscle. Citrate synthase, a non-iron containing citrate cycle enzyme, and long chain acyl-CoA dehydrogenase (LCAD), used as a marker for the fatty acid oxidation pathway, were unaffected by the iron deficiency. Oleate oxidation by muscle homogenates was increased by high fat feeding and decreased by iron deficiency despite high fat feeding. The high fat diet caused severe insulin resistance of muscle glucose transport. Iron deficiency completely protected against the high fat diet-induced muscle insulin resistance.The results of the study argue against the hypothesis that a deficiency of the electron transport chain (ETC), and imbalance between the ETC and β-oxidation pathways, causes muscle insulin resistance