Sonographic correlation of thyroid nodules with ultrasound aided fine needle non aspiration cytology

Objectives: To describe the sonographic patterns of thyroid nodules in patients undergoing thyroid ultrasound, to correlate sonographic characteristics of thyroid nodules to ultrasound aided fine needle non aspiration(US-FNNA) cytology and to determine the sensitivity and specificity of Ultrasound in characterising thyroid nodules.Design: Cross sectional study.Setting: The department of Radiology at Mulago Teaching and National Referral Hospital in Kampala Uganda. The Hospital is a 1,500-bed unit providing tertiary diagnostic, curative, rehabilitative, preventive and teaching services. Patients were recruited from both Medical and Surgical outpatient thyroid clinics.Subjects: All patients with thyroid nodules > 5 mm and who consented to have US aided-FNNA were enrolled consecutively.Results: One hundred and eighty one (181) participants were enrolled and final diagnoses were concluded in 177 of the participants (analysed) while four participants were excluded due to inadequate samples. The participants' age range was 19 to 83 years (mean age - 42 years ) and 93% were females. Five percent (n=9) were malignant, 18% suspiscious (n=34) and benign (n=134). The sonographic characteristics that were significantly correlated with final cytology diagnosis were a taller than wide AP diameter, micro-calcifications, heterogeneous and hypoechoic echo-patterns. Heterogeneous, hypoechoic and central vascularity had the highest sensitivity while wider than tall, anteroposterior diameter, no lymphadenopathy, and macro/no calcifications had the highest specificity.Conclusion: Sonographic features of micro-calcifications, taller than wide AP diameter, central vascularity and hypoechogenicity warrant US-FNNA. A bigger study correlating thyroid sonography with histological diagnosis is recommended

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum.Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively.Results: Radiologists’ and students’ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated.Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM

Emergency Ultrasound Predicting the Need for Therapeutic Laparotomy among Blunt Abdominal Trauma Patients in a Sub-Saharan African Hospital

Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient's evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC. Results. In total, 195 patients were evaluated; M : F ratio was 6 : 1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%. Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings

Genome-wide diversity and structure variation among lablab [Lablab purpureus (L.) Sweet] accessions and their implication in a forage breeding program

Open Access Article; Published online: 19 Mar 2021Most orphan crops have not been fully sequenced, hence we rely on genome sequences of related species to align markers to different chromosomes. This hinders their utilisation in plant population improvement programs. Utilising the advances in the science of sequencing technologies, the population structure, relatedness, and genetic diversity among accessions can be assessed quickly for better exploitation in forage breeding programs. Using DArTseq technology, we studied the genetic and structural variation in 65 Lablab purpureus (L.) Sweet conserved gene-bank accessions using 9320 DArTseq-based SNPs and 15,719 SilicoDart markers. These markers had a low discriminating ability with mean polymorphic information content (P.I.C.) of 0.14 with DArTseq-based SNPs and 0.13 with SilicoDart markers. However, the markers had a high mean call rate of 73% with DArTseq-based SNPs and 97% with SilicoDart markers. Analysis of molecular variance revealed a high within populations variance (99.4%), indicating a high gene exchange or low genetic differentiation (PhiPT = 0.0057) among the populations. Structure analysis showed three allelic pools in variable clusters of ΔK = 3 and 6. Phylogenetic tree of lablab accessions showed three main groups with variable membership coefficients. Most pairs of accessions (40.3%) had genetic distances between 0.10 and 0.15 for SilicoDart markers, while for DArTseq-based SNPs, (46.5%) had genetic distances between 0.20 and 0.25. Phylogenetic clustering and minimum spanning analysis divided the 65 accessions into three groups, irrespective of their origin. For the first time, this study produced high-density markers with good genom coverage. The utilisation of these accessions in a forage program will base on the information from molecular-based grouping. The outcomes uncovered the presence of noteworthy measure of variety in Uganda, CIAT and ILRI accessions, thus demonstrating an opportunity for further marker-trait-association studies

A gentle push towards improved hygiene and food safety through ‘nudge’ interventions

Most of the perishable food in low- and middle-income countries is sold in informal markets where food handlers are not usually trained in good hygienic practices. There are different approaches to improve food safety in those markets, some of which include capacity building. However, one-off trainings are not usually sustainable as behaviours are deeply rooted and often lead to unconscious practices that can increase risk of food contamination. Close follow-up is intense in terms of human and financial resources. Nudges have been described to influence behaviour with varying results, partly depending on whether they have been imposed on or co-created with the end-users. In this study we describe the human-centred-design process from identifying critical control points between slaughter and retail to co-creating nudges that could potentially lead to better compliance of meat handlers in Uganda with good hygienic practices. Three of the WHO “Five Keys To Safer Food” were selected as the target behaviours to improve. The qualitative research was implemented in the greater Kampala area between October 2020 to December 2021 and involved 119 meat handlers, pork joint customers, food safety and veterinary technical experts and over 20 project stakeholders. Findings from the initial ‘explore’ phase generated a number of insights on meat handlers’ perceptions and attitudes that were later used to generate ideas and solutions in cocreating nudges during the ‘experiment’ phase: 1) Meat handlers eat the pork they handle at work and have low risk perception; 2) Meat handlers feel their practices are acceptable; 3) Meat handlers see ‘broken windows’ which set the norm for unhygienic behaviour; 4) Meat handlers follow the path of least resistance; 5) Meat handlers keep up appearances for customers; and 6) Owners want to see returns on hygienic investments. Fourty-two early prototypes were co-created with potential end users and after several iterations, two nudge kits emerged, e.g. the “Keep Clean Loop” and the “Tricolour Kitchen”. In a subsequent pilot test we assessed if the nudges help reducing the burden of foodborne pathogens and if behaviour of meat handlers changes sustainably

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum. Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively. Results: Radiologists′ and students′ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated. Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM

Application of Case Report-Writing in the Training of Radiology Post Graduate Students at Makerere University.

Background: Postgraduate medical education is much sought after and has become an issue of global significance, appeal and dimensions. The Radiology postgraduate training at Makerere University has been in existence since 1980. As part of their training students are required to write up 30 cases with the help of their lecturers. Methods: We set out to evaluate the role of case report writing in the training of Radiology postgraduate students. A document analysis of 22 case report sets was done. Questionnaires with closed and open ended questions were administered to the 10 Radiologists and 6 students to get their opinions and ideas on the process and how it could be improved. The quantitative data was analyzed by a statistician and focused on the closed-ended statements. The qualitative data was analyzed by the authors with the help of a qualitative expert. Results: The radiologists and students agreed that case report writing helped students acquire a wide range of competences. They also agreed that it is a reliable and valid method of assessment and has a positive impact on learning. The respondents identified problems that were encountered in the process. They have problems identifying cases that are fully worked up and also their work was made challenging because of poor technology, limited access to references and high cost of producing the cases. The cases exposed the students to a wide range of cases and investigations in radiology and helped them integrate Clinical Medicine and Radiology. Conclusion: Case report writing is a good way of training and assessing post graduate students. It is motivational and also helps them acquire a wide range of competences specifically ability to write scientific articles