Management of Testicular torsion in Mulago Hospital over a 5-year period

A retrospective study of patients seen in Mulago Hospital with a clinical diagnosis  of testicular torsion between 1993 and 1997 inclusive was undertaken. There were a total of 102 cases of torsion of the testis. Their ages ranged between 16 and 20 years. Over 50% of the patients reported to the hospital more than 48 hours after the onset of their symptoms and in 75% of the cases, the testes were already gangrenous on admission. The management included exploration, derotation and fixation of both testes if found viable or orchidectomy and fixation of the contra lateral testis if gangrenous. The study showed that there is need for increased level of awareness of this disease among health workers, parents, teachers and adolescents if delay in diagnosis is to be avoided.Key words: Testis, testicular, torsion, and management

Levels of Bifurcation of the Sciatic Nerve among Ugandans at School of Biomedical Sciences Makerere and Mulago Hospital Uganda

Background: The sciatic nerve is derived from the lumbo-sacral plexus, It is the thickest nerve in the whole body, it exits the gluteal region through the lower part of the greater sciatic foramen, it is the main innervator of the posterior thigh, the leg and foot, it usually ends halfway down the back of the thigh by dividing into the tibial and common peroneal nerves, and these terminal branches supply the leg and foot. The position of division of this nerve varies, it may occur within the pelvis, gluteal region, upper and ,mid thigh, and distal thigh ,Its injury if it involves the whole nerve, may lead to loss of sensation, in posterior thigh, whole leg and foot, with loss of function of all muscles in posterior thigh, whole leg and the foot. And this results into failure to dorsiflex the foot a condition referred to as foot drop. The level of bifurcation of the sciatic nerve above the transverse popliteal crease is useful during sciatic nerve block, hence the need for healthcare workers to have adequate appreciation of the applied anatomy of the nerve. The main objective of the study was to determine the level of bifurcation of the sciatic nerve above the transverse popliteal crease among Ugandans at Mulago Hospital Complex.Methods: This was a cross-sectional descriptive study conducted at the Department of Anatomy, School of Biomedical sciences, Makerere University and Mulago Hospital mortuary. Eighty adult cadavers were dissected in the gluteal region and posterior thigh to establish the level of bifurcation of the sciatic nerve above the transverse popliteal crease, and the distance from the crease was measured in cm using a caliper calibrated in millimeters.Results: Eighty left lower limbs of 56 male and 24 female adult cadavers were dissected to expose the sciatic nerve one side of the body was dissected to control for left to right variations, however in another study, the variations on two sides would be compared.., The heights of the cadavers ranged from 145 to 182 cm with a mean of 162.8 cm. The nerves bifurcated in the gluteal region and posterior thigh in 62 cadavers (77.5%) and 18 in the pelvis (22.5%). Of the 62 nerves that bifurcated higher in the pelvis, the level of bifurcation ranged between 3.8 and 32.5 cm but most of the bifurcations occurred between 3.8 and 12 cm above transverse popliteal crease. In four of the nerves that exited the gluteal region after bifurcation, the nerves reunited before the final bifurcation occurred in the thigh.Conclusions: The Bifurcation of the sciatic nerve occurs at variable distances from the transverse popliteal crease and appreciation of these variations is essential. More than 22% of all nerves leave the pelvis as two separate nerves and therefore the sciatic nerve trunk cannot be wholly traced or used for anesthetic block in the gluteal region or thigh for procedures in the leg and foot. Only 62 individuals (77.5%) had sciatic nerves in the gluteal region and thigh, and within this group, the vertical distance of bifurcation ranged between 3.8 and 32.5 cm transverse popliteal crease

Medical audit on problem analysis and implementing changes at the Health Unit level

Background: Decentralization is one of the reforms the Uganda government adopted to improve public services delivery. However, human resource numbers and capacities in local governments remain below the required level and this coupled with severe resource constraints make it increasingly difficult to deal with enormous workload in public health units. The authors responded to these human resource demands and needs in health service delivery by introducing hospital medical audit on problem analysis and implementation of changes through continuing medical education to health care workers. The main objective of this study was to introduce hospital medical audit on problem analysis and implementation of changes in health units in order to reduce morbidity and mortality.Methods: A feasibility study was done to find out the effects of decentralization on the health service delivery and to assess the need for continuing medical education. Twelve problematic clinical areas were identified, modules developed, tested and eventually used to train selected health care workers on hospital medical audit to improve health service delivery.Results: A total of 270 health care workers and 400 paramedical students were trained on hospital medical audit by identifying causes of complications associated with common clinical procedures done in their health units and then provide solutions that can be implemented. On prevention of HIV/AIDS and malaria spread, three different levels at which the two could be prevented from spreading were identified and discussed. Infection control and continuing medical education committees were formed where they did not exist.Conclusion/Recommendation: Hospital medical audit on problem analysis and implementation of changes in health units is highly effective in stimulating and empowering health care workers and hospital administrators to analyze their own situations and provide implementable solutions to their health care problems. There is need to introduce hospital medical audit in all the districts in Uganda to improve health services delivery

Medicinal plants popularly used in the Xingó region – a semi-arid location in Northeastern Brazil

The aim of this study was to identify plant species among the diverse flora of the caatinga ecosystem that are used therapeutically. Research was undertaken in the municipalities of Piranhas and Delmiro Gouveia, in the Xingó region (state of Alagoas, NE Brazil). In order to identify the medicinal plants used in this region, semi-structured questionnaires were applied. The species cited were collected and sent to the Xingó Herbarium for taxonomic analysis. The relative importance (RI) of each species cited was calculated to verify their cultural importance. The therapeutic indications attributed to the species were classified under 16 body systems. A total of 187 medicinal species were cited, from 64 families and 128 genera. The main indications for medicinal plant use were against common colds, bronchitis, cardiovascular problems, kidney problems, inflammations in general, and as tranquilizers. Approximately 16% (30 plant species) were versatile in relation to their use, with an Relative Importance value over 1, having been indicated for up to nine body systems. The body systems that stood out the most were: the respiratory system, the gastrointestinal system, and infectious diseases. Most cited plant parts used for medicinal purposes were flowers, leaves, and inner stem bark

Lean production and manufacturing performance improvement in Japan, the US and UK 1994-2001

This paper reports the findings of a longitudinal study into manufacturing performance, lean production principles and buyer supplier relations in the Japanese, US and UK automotive industries. A total of 26 first tier component makers in the three countries were subject to detailed benchmarking exercises in 1994 and in 1999-2001. In each exercise data on labour productivity and quality performance were obtained, along with a series of quantitative measures indicating the extent to which each plant conformed to ‘lean production’ principles. The results show that the Japanese plants improved their labour productivity by around 20 per cent between 1994 and 2001, whilst productivity in the US plants remained flat over the same period. All plants improved their quality performance during the period, but the Japanese plants retained their lead with an average external defect rate of 81 parts per million (ppm), compared to 111 ppm for the US plants and 416 ppm in the case of the UK plants. Measures of leanness in the supply chain (inventory levels, delivery frequencies and so on) should be sensitive to any weakening of the inter-firm relationships that have historically characterized the Japanese auto industry. These measures showed no evidence of such weakening, although qualitative evidence suggested that a polarization of the Japanese auto industry may be occurring under the influence of foreign capital, with independent firms such as Toyota and Honda (and their suppliers) retaining a stronger ‘Japanese’ character than their counterparts who have entered into equity relationships with non-Japanese companies

Understanding the evolution of the entrepreneurial university:The case of English Higher Education

There has been strong policy interest in universities becoming more entrepreneurial and engaging in knowledge exchange activities as part of an expanding third mission agenda. However, our understanding of the evolution and diversity of such activities is limited. Using longitudinal data from the Higher Education Business Community Interaction (HEBCI) Survey, this study examines the evolving configuration of universities' knowledge exchange activities and stakeholders by analysing distinctive clusters of English universities. We find an increasingly diverse profile of third mission activities across different types of universities: within old, more established universities, Russell Group universities increasingly focus on research‐oriented activities typically in partnership with large firms and non‐commercial organisations; while another group engages in a broad range of knowledge exchange activities with low specialisation over time. Newer, less research intensive, universities increasingly rely on activities such as consultancy and formation of spin‐offs. A decreased engagement with small and medium enterprises and a lower share of knowledge exchange activities at the regional level are observed across the time studied for all universities.JRC.B.4-Human Capital and Employmen

A comparative study on the effects of a pesticide (cypermethrin) and two metals (copper, lead) to serum biochemistry of Nile tilapia, Oreochromis niloticus

The present study was designed to compare the responses in freshwater fish Oreochromis niloticus exposed to a synthetic pyrethroid, cypermethrin (CYP); an essential metal, copper (Cu); and a nonessential metal, lead (Pb). Fish were exposed to 0.05 μg/l CYP, 0.05 mg/l Cu, and 0.05 mg/l Pb for 4 and 21 days, and the alterations in serum enzyme activities, metabolite, and ion levels were determined. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities increased in response to CYP, Cu, and Pb exposures at both exposure periods. While elevations in alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) activities and in cholesterol level were observed in pesticide-exposed fish at 4 and 21 days, they increased in Cu- and Pb-exposed fish at 21 days. Although metal-exposed fish showed increases in cortisol and glucose levels at 4 days followed by a return to control levels at the end of the exposure period, their levels elevated in pesticide-exposed fish at both exposure periods. Total protein levels decreased in Pb- and pesticide-exposed fish at 21 days. Na+ and Cl− levels decreased in pesticide-exposed fish at both exposure periods and in Cu- and Pb-exposed fish at 21 days. The exposures of pesticide and metals caused an elevation in K+ level at the end of the exposure period. The present study showed that observed alterations in all serum biochemical parameters of fish-treated pesticide were higher than those in fish exposed to metals

Systematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer

As knowledge on the causation of cancers advances and new treatments are developed, early recognition and accurate diagnosis becomes increasingly important. This review focused on identifying factors influencing patient and primary care practitioner delay for upper gastrointestinal cancer. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Included studies were those evaluating factors associated with the time interval between a patient first noticing a cancer symptom and presenting to primary care, between a patient first presenting to primary care and being referred to secondary care, or describing an intervention designed to reduce those intervals. Twenty-five studies were included in the review. Studies reporting delay intervals demonstrated that the patient phase of delay was greater than the practitioner phase, whilst patient-related research suggests that recognition of symptom seriousness is more important than recognition of the presence of the symptom. The main factors related to practitioner delay were misdiagnosis, application and interpretation of tests, and the confounding effect of existing disease. Greater understanding of patient factors is required, along with evaluation of interventions to ensure appropriate diagnosis, examination and investigation

Efficacy of topical cobalt chelate CTC-96 against adenovirus in a cell culture model and against adenovirus keratoconjunctivitis in a rabbit model

BACKGROUND: Adenovirus (Ad), associated with significant morbidity, has no topical treatment. A leading CTC compound (CTC-96), a Co(III )chelate, was found to have potent in vitro and in vivo antiviral efficacy against herpes viruses. In this study CTC-96 is being tested for possible anti-Adenovirus activity. METHODS: The biological anti-adenovirus activity of CTC-96 in concentrations from 5 to 250 ug/ml, was evaluated initially by viral inactivation (viral exposure to CTC-96 followed by dilution and inoculation of cells), virucidal (viral exposure to CTC-96 and inoculation of cells without dilution) and antiviral (effect of CTC-96 on previously adsorbed virus) plaque assays on HeLa (human cervical carcinoma), A549 (human lung carcinoma) and SIRC (rabbit corneal) cells. After verifying the antiviral activity, New Zealand White rabbits were infected with Ad-5 into: 1) the anterior cul-de-sac scarifying the conjunctiva (Group "C+"); 2) the anterior cul-de-sac scarifying the conjunctiva and cornea (Group "CC+"); 3) the stroma (Group "CI+"). Controls were sham-infected ("C-", "CC-", "CI-"). Other rabbits, after "CC", were treated for 21 days with: 1) placebo, 9x/day ("-"); 2) CTC-96, 50 ug/ml, 9x/day ("50/9"); CTC-96, 50 ug/ml, 6x/day ("50/6"); CTC-96, 25 ug/ml, 6x/day ("25/6"). All animals were monitored via examination and plaque assays. RESULTS: In vitro viral inactivation, virucidal and antiviral assays all demonstrated CTC-96 to be effective against Adenvirus type 5 (ad-5). The in vivo model of Ad keratoconjunctivitis most similar to human disease and producing highest viral yield was "CC". All eyes (6/6) developed acute conjunctivitis. "CI" yielded more stromal involvement (1/6) and iritis (5/6), but lower clinical scores (area × severity). Infection via "C" was inconsistent (4/6). Fifty (50) ug/ml was effective against Ad-5 at 6x, 9x dosings while 25 ug/ml (6x) was only marginally effective. CONCLUSION: CTC-96 demonstrated virucidal activity against Ad5 in tissue culture with HeLa, A549 and SIRC cell lines. Animal Model Development: 1) "CC" produced conjunctival infection with occasional keratitis similar to human disease; "CI" yielded primarily stromal involvement; 2) "C" consistently produced neither conjunctivitis nor keratitis. CTC Testing: 1) Conjunctivitis in all eyes; 2) Resolution fastest in "50/9" ("50/9". "50/6" > "25/6" > "-"); 3) Efficacy in "50/6" was not statistically different than "50/9"; 4) Conjunctival severity was lower in treatment groups then controls; 5) Little corneal or intra-ocular changes were noted