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

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