Spina Bifi da Cystica; features and early postoperative outcomes an experience in Kampala

Introduction: Spina Bifi da is one of the most serious developmental disability of the infant. The prevalence of Spina Bifi da varies across time, region, race and ethnicity. Worldwide, it accounts for as many as 4.7 in 10,000 live births. Although Spina bifi da in its entirely is commonly seen in neurosurgical practice there is sparse literature on this disabling congenital anomaly in the Ugandan context. This study therefore aimed at describing the clinical features and early post operative outcomes.Methods: A prospective descriptive study recruited children with Spina Bifi da Cystica admitted to Neurosurgical ward over a period of 11 months from May 2010 to March 2011, at Uganda’s National Referral Hospital. Clinical presentations of these patients were obtained by performing a general and neurological examination and using a standardized questionnaire. The patients were followed up for two weeks to establish early outcomes.Result: A total of 51 patients with Spina Bifi da Cystica were studied, representing 3.9% of all patients admitted on the unit that period. Out of those 54.9% were males and 45.1% were females. The mean age of their mothers was 23.8 years and the second birth rank was the mostly affected. Family history of Spina Bifi da was present in 7.8%. Nearly all patients (98%) had myelomeningocele with a most common site being lumbosacral (47.1%). Hydrocephalus was noted in 72.5% of patients before surgery and talipes equinovarus was the other most associated congenital anomaly. Forty three patients were operated on. The rest 8 patients died before surgery. The mean preoperative hospital stay was 17.6 days.Conclusion: Patients had long pre operative lapse before the definitive management was offered and all the deaths occurred during this period. Exploration of factors responsible for this delay may enhance opportunities for timely intervention. Keywords: Spina Bifi da Cystica, surgery, early outcome

Knowledge and Practice of Breast Self Examination among Female Students in a Sub Saharan African University

Background: Breast cancer is the most common cancer among women in many parts of Africa. Facilities for screening and early detection are extremely limited yet early diagnosis improves survival. This study explored the practice of Breast Self Examination among female university students as a means of screening and early detection in a low resources environment.Subjects and Methods: A cross sectional descriptive study at a Sub Saharan university. A call for volunteers to the study was made; a pretested standardised questionnaire was used for data collection. The process was limited to an interview and a physical examination. IRB approval was granted before the study began.Results: A total of 320 participants volunteered, 314 were recruited. The majority were aged between 21 and 25. The range was between 19 to 31 years. There was a high awareness of Breast self Examination (BSE) of 81.5%, 30% had ever performed a BSE, 14% performed it regularly, 8% knew the correct monthly timing, the technique was accurately demonstrated by 1% of participants. 4.8 were found to have breast lumps.Conclusion: There is a likelihood of most young women in the country practicing BSE inadequately. There is a need for widespread BSE campaigns emphasizing the correct technique and a need to evaluate BSE efficacy. The prevalence of breast lumps among young women attending this university was comparable to other community prevalence studies in this age group

Challenges Facing Surgical Training in the Great Lakes Region in Sub-Saharan Africa: a Review Article

Background: There is a severe shortage of health workers in sub-Saharan Africa yet this subcontinent experiences a significant proportion of the world’s disease burden. This shortage is further reflected in the lack of personnel for surgical sub specialities such as orthopaedics, paediatrics, neurology and urology to mention but a few.Objective: This review therefore sought to summarize the current literature on the state of surgical training in sub Saharan Africa, discuss the  challenges faced and the possible ways to overcome these challengesMethods: We performed online searches of electronic databases i.e. PUBMED, MEDLINE and African Journals online that feature many African Journals not index by the ‘regular’ databases.Results: The searches returned 88 articles and 24 of which were included in the review, we present results focused on; training capacity and methods, scope of practice, technology and surgery, and low research capacity and output.Conclusion: The future of surgical training in Africa will depend on the ability of the leadership to create or and adopt innovative educational technologies, recruit and retain trainers and attract trainees on one hand and on the other, the growth of demand for quality surgical care in the great lakes regions. For those that have excelled in training need to build on those successes and share their stories.Keywords: Surgical Training, challenges, sub- Saharan Afric

Improving Recruitment of surgical trainees and Training of Surgeons in Uganda

Background: The surgical work output in Uganda is qualitatively and quantitatively inadequate. The number of surgeons is estimated at 100 for a population of over 26 million Ugandans. Thispaper reports on how to improve recruitment of surgical trainees and training of surgeons in Uganda, focusing on perceptions of potential trainees, trainers, and medical administrators.Methods: This was cross sectional, descriptive study sampled at least 50% of each of the relevant category of interviewees. Self-administered questionnaire and focus group discussions were used tocollect data, which was analyzed manually using a master sheet. It was approved by the Ethics and Research Committee.Results: Paediatrics and Public Health were rated as the disciplines of choice for postgraduate training in Uganda. The reasons why potential trainees would shy away from specialized surgical training were excessive workload, risk of catching HIV/AIDS, low financial returns and a poorlearning environment. The major bottlenecks in surgical training, which were cited, included inadequate number of scholarships, inadequate supervision by trainers, inadequate facilities and poor work conditions for trainers.Conclusion: The remedies to this complex problem revolve round providing more resources, (human, materials, money), improving supervision by the trainers, advocacy for an evidence basedcurriculum content and availing more funding into the Medical Education sector to improve Human Resource for Health development

Prevalence of HIV/AIDS among Breast Cancer Patients and the associated Clinico-pathological features

Introduction: There is uncertainty as to the exact interaction between HIV and Breast Cancer. Available studies are inconclusive about any relation whether causal or protective and the number of patients in these studies small.Objective: To determine the prevalence of HIV among confirmed incidentbreast cancer cases and to describe the associated clinico-pathologicalfeatures.Design: Analytical cross sectional studyMethods: Over a period of 6 months consecutively eligible patients wererecruited from the Mulago Hospital breast clinic. Breast lesions were biopsied and blood withdrawn for HIV sero-survey. Collected data wasdouble entered into Epidata version v 3.1.1, exported to STATA 10.0 foranalysis.Results: Sixty two breast cancer patients consented to participate in thestudy and of these, 22(35.48%) were positive for HIV compared to HIVprevalence in the general population of 6-7%. All the participants werefemale. The mean age of HIV negative subjects was 45 years (range:21-80 years) and for HIV positive subjects was 32.4 years (range 18-52years). There was a signifi cant association between HIV status and age,BMI and CD4 Counts as well as for histological grade and stage (P< 0.024).Conclusion: The prevalence of HIV among the studied breast cancer group was signifi cantly higher than that in the general population. HIV was associated with poor prognostic factors. A high index of suspicion of the co-existence of these two diseases in a context of high HIV prevalence is warranted. Future studies should explore for a causal association

Thyroid Dysfunction among Young Adults in Uganda

Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population.Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee.Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH (1.67) with a high fT4 (22.31) and one with a low TSH (0.03). The mean age of participants was 23 years, there were slightly more males 1.3:1.Conclusion: The prevalence of thyroid dysfunction in this cohort was low but falls in the range found elsewhere. These findings could inform the criteria of screening asymptomatic otherwise young health adults

Metastatic Breast Cancer and Hormonal Receptor Status among a Group of Women in Sub Saharan Africa

Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breast cancer patients in Uganda present with advanced disease. Many studies show that metastatic lesions frequently lodge in bones, lung and liver. Tumour hormone receptor status correlates with site of metastatic lesions and survival among breast cancer patients.Objective: To determine the sites of metastatic breast lesions and how they relate to the hormonal receptor status.Methods: In this cross sectional descriptive study, 71 women with histologically confirmed incident breast cancer with metastases were analysed, their hormonal receptor status was determined. All patients underwent a chest X-ray, an abdominopelvic ultrasound scan and a bone scan. The χ² and t tests were used to compare variables for statistical differences.Results: The mean age of participants was 45 years. Most metastases were to bone 56% (40/71), of these 45% (32/71 ) tumours were exclusive to bone and 94% of these (30/32) were ER+ . Of the 13 (18% of all patients) who had metastases to the liver, 7 were exclusive to the liver, and 1 (14.%) was ER positive. Of the 30 (42 %) patients with lung metastases, 23 patients were exclusive to lungs and 9/30 (39%) were ER+. In all 68% (48/71) were ER+, and bone metastases were associated with ER positivity and low grade tumors.Conclusion: Breast metastases had a preponderance to bone in this largely premenopausal group of women and these tumors were mostly ER positive. In the absence of tests to determine ER status, empirical antihormonal therapy may be used.Key words: Metastatic Breast Cancer, Hormonal Receptor Statu

Iodine Excess is a Risk Factor for Goiter Formation

Background: Goiters have been associated with iodine deficiency. Although universal salt iodization in Uganda achieved a household coverage of 95%by 2005, goiter rates are still high. This study investigated the association between iodine excess and goiter.Methods: In a case control study, urinary iodine levels, complete blood count, T3, T4 and TSH levels were determined.Results: We recruited, 60 goiter and 63 non goiter patients. The median urine iodine level for goiter patients was significantly higher than in non-goiter controls. Urinary iodine excretion was sufficient in 43%, more than sufficient in 31% and excess in 10% of cases. There was an association between excess urinary iodine levels and goiter.Conclusion: Urinary iodine excess was significantly associated with occurrence of goiter.Key Words: Iodine excess, Goiter, Sub Saharan Afric

Breast transillumination a viable option for breast cancer screening in limited resource settings?

Background: Mammography is an established screening tool for breastcancer in high-income countries but may not be feasible for most resourcepoor nations. Alternative modalities are needed to mitigate the impact of the increasing incidence and mortality due to breast cancer. This may require the development of new technologies or reevaluation of old technologies applicable to resource limited settings.Objective: To determine the sensitivity and specificity of breast transillumination as compared to mammography and to describe featuresof benign and malignant breast lesions as seen with breast transillumination.Methods: A single group descriptive analytical study was conductedover a six month period (2011) in the breast unit of Mulago Nationalhospital. Eligible participants were consecutively sampled. Participantsunderwent Clinical Breast Examination (CBE), breast transillumination(BT), mammography (MG) and histopathological analysis of identifiedbreast lumps. Sensitivity, specificity and predictive values werecalculated. Features of the masses detected by transillumination werethen described.Results: The number of participants recruited was 201 (mean age 42years, range 30-80 years). The average palpable lump size was 3.8cm (range 0.5 to 10 cm). BT had a sensitivity of 63.2% (PPV 86.8%) anda specificity of 89.5% (NPV 61.2%) with mammography as the referencestandard. Also, 73.3% of breast lumps with irregular margins and 88.5%with dense opacity at transillumination turn out to be malignant athistopathology examination.Conclusion: The Breast transillumination technique had a moderatesensitivity of 63.2%. This warrants a large scale population-basedevaluation of BT as a screening tool. This technique may not substitutemammography but to be considered an option where mammographyaccess is limited