A Comparision of Clinical Diagnosis and Knee Arthroscopy Findings at Mulago Hospital

Background: Many patients present to the orthopaedic surgeon with complaints of knee pain. In many such cases making a diagnosis based on clinical examination is often difficulty and frequently inaccurate. This study sought to document the common findings at knee arthroscopy and how they compare with clinical impressions.Methods: A cross-sectional study of 34 patients undergoing diagnostic knee arthroscopy with undetermined diagnosis was conducted at Mulago Hospital. The preoperative clinical provisional diagnosis and the findings at arthroscopy were documented, compared and analysed.Results: The commonest clinical diagnosis was medial meniscal tear (21%), while the most frequent finding at arthroscopy was osteochondral lesions (27%). The highest correlations between clinical impressions and arthroscopic findings were in ACL tears and osteoarthritis. The overall accuracy of clinical examination was 87.2%.Conclusion: Clinical examination is a useful tool in diagnosing knee pathologies. In Mulago, the accuracy of the clinical impressions as proved at arthroscopy is high

Single stage release surgery for congenital constriction band in a clubfoot patient managed at a Teaching Hospital In Uganda: A case report

Congenital constriction band or amniotic band syndrome is a rare condition with a prevalence of 1:11200. It is characterized by presence of strictures around a body part, commonly around the distal part of the extremities. These bands can be treated with a single or staged approach. This study presents the case of a 3 month old infant who presented with a type III constriction band localized on the right leg and surgery was  indicated. A single  stage multiple Z-plasty was performed. The postoperative course was uneventful and the outcome was satisfactory at 10 months of follow-up. A single-stage constriction band release approach provided satisfactory results; both functional and aesthetic results and is feasible in our setting. Key words: Constriction bands, Single stage release, Strictur

Deep venous thrombosis in patients with acute traumatic spinal cord injury: prevalence and patterns in a major teaching hospital in Uganda

Background: Spinal cord injured patients are at high risk of developing Deep Venous Thrombosis (DVT). This is because spinal cord injury favours two of the Virchow’s triad of factors for DVT; thus endothelial injury (trauma) and immobility (venous stasis). DVT and Pulmonary Embolism (PE) have long been known to be a major health problem in the West. However, the problem in Africa has been underestimated due to lack of data. Materials and methods: A cross sectional descriptive study was carried out at the spine unit of Mulago National Referral and Teaching Hospital from September 2012 to February 2013. Traumatic spinal cord injured patients who met the inclusion criteria were assessed for DVT using the model developed by Wells and colleagues. This included clinical assessment, D-dimer assay and Doppler sonography. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations. Results: Out of 53 patients enrolled in the study, 48 were males and 5 were females. Most of the patients were in the age group of 21 to 40 years. DVT was found in 6 out of 53 patients representing 11.3%. All the patients who had DVT were in ASIA class A. There was bilateral involvement in one patient whereas two patients had thrombi in the left and three had thrombi in the right. A total of ten different thrombi were found, three proximal and seven distal. Clinical signs were found to be unreliable in the diagnosis of DVT in spinal cord injured patients. D-dimer test in combination with the Wells score was found to be a useful screening test and could reduce the need for further test if negative. Conclusion: We found a prevalence of 11.3% in the spinal cord injured patients. This prevalence was comparable to studies done in Asia but within the lower border of studies done in Caucasians. Distal DVT was more common as opposed to Caucasians where proximal DVT is more common. Clinical features of DVT were found to be unreliable in spinal cord injured patients due to the neurological injury. Keywords: Deep vein thrombosis, Pulmonary embolism, Traumatic spinal cord injury, Wells score, D-dimer assays, Doppler sonography EAOJ; Vol. 7: September 201

A Comparision of Clinical Diagnosis and Knee Arthroscopy Findings at Mulago Hospital

Background: Many patients present to the orthopaedic surgeon with complaints of knee pain. In many such cases making a diagnosis based on clinical examination is often difficulty and frequently inaccurate. This study sought to document the common findings at knee arthroscopy and how they compare with clinical impressions. Methods: A cross-sectional study of 34 patients undergoing diagnostic knee arthroscopy with undetermined diagnosis was conducted at Mulago Hospital. The preoperative clinical provisional diagnosis and the findings at arthroscopy were documented, compared and analysed. Results: The commonest clinical diagnosis was medial meniscal tear (21%), while the most frequent finding at arthroscopy was osteochondral lesions (27%). The highest correlations between clinical impressions and arthroscopic findings were in ACL tears and osteoarthritis. The overall accuracy of clinical examination was 87.2%. Conclusion: Clinical examination is a useful tool in diagnosing knee pathologies. In Mulago, the accuracy of the clinical impressions as proved at arthroscopy is high

The interface between blood preparation and use in Uganda

Background and Objectives The interface between preparation and use of blood impacts directly on the outcome of hemotherapy. The present study explores the knowledge and opinions of key players at, practical realities at, and quality improvement strategies of this interface. Materials and Methods We surveyed clinicians (n = 81) and blood bank staff (n = 25) to assess their knowledge on key issues in their counterparts' working domains, the turnaround time on effecting a blood order from a hospital transfusion laboratory and strategies to improve communication of blood needs to blood banks. Results Out of 81 clinicians, 20 knew the four available blood products while only 17 knew the three uses of these products. Twenty-three blood bank staff reported the patient's condition as the main factor on which blood orders are based. Forty-four (54.3%) clinicians reported reception of a blood product within an hour of placing the order. Addressing infrastructure and human resource were some of the strategies suggested to improve this step of the transfusion chain. Conclusions The knowledge of staff at the extreme ends of the clinical interface in their counterparts' working domain is far from adequate. However, they have well formed opinions on strategies to improve this interface

Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study

<b>Background:</b> Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. <b> Materials and Methods:</b> An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands. <b> Results:</b> In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. <b> Conclusion:</b> The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines

Bottlenecks of blood processing in Uganda

Aim: To identify where and why delays occur in Uganda blood banks. Background: The timely provision and supply of safe and efficacious blood components to hospitals depends on sound systems in the processing blood banks. Poorly managed systems lead to apparent blood shortages in hospitals and increase discard rates due to expiry before dispatch. Materials and methods: We reviewed records of 4126 units of whole blood delivered by the mobile collection teams to a major regional blood bank, in the period 1 March 2009 to 30 June 2009, to ascertain the time intervals between the critical steps in the blood processing chain. This was followed by interviews with staff in two blood banks to establish the causes of process delays. Results: The average duration between blood collection and final labelling (release from quarantine for final storage) was 15.4 (SD 10.8) days. In timeline, the step between matrix generation and grouping was (median duration 8 days) the longest, whereas grouping to labelling was the shortest (median duration 2 days). Blood expiry had the highest discard rate (0.17%) among the non-transfusion transmissible infection marker causes. A minimally facilitated small staff contributed to the process flaws. Conclusion: A considerable amount of blood does not reach hospitals because of process delays between collection and ultimate dispatch. This is caused by a thin staff working with inadequate materials, out-of-date methods and in an overcrowded environment. Provision of adequate staff and improved financial allocations to the Uganda Blood Transfusion Services will mitigate this situation

Blood loss and contributing factors in femoral fracture surgery

Background: Substantial blood losses frequently accompany orthopedic procedures. Methods: We prospectively noted peri-operative hemoglobin changes in 93 patients undergoing surgery for femoral fracture with an aim of establishing blood loss and related factors. Results: The mean total blood loss assessed 72 hours after the surgical procedure was 3.31 (SD 1.56) units of whole blood. A multiple regression analysis revealed diathermy use and a simple fracture pattern as significant factors in reducing blood loss (p<0.01). Conclusions: Open intramedullary fixation of femur fractures leads to considerable peri-operative blood loss. This is can be reduced by use of diathermy during surgery

Surgical blood order equation in femoral fracture surgery

Aim: This study aimed at establishing the clinical utility of the surgical blood order equation (SBOE) in patients undergoing femoral fracture surgery. Background: A blood ordering schedule defines the perioperative blood use in elective surgery. It lists the number of units of blood required for each procedure preoperatively. Materials and methods: A case-control study was performed among homogeneous groups of patients (n = 62 each) undergoing open reduction and internal fixation of femoral fractures. Correct prediction of blood use in the group of patients using the SBOE was compared to the group whose blood orders were made without any guideline. Results: The surgical blood ordering equation was exactly correct in ordering blood for 46 (74 center dot 2%) of 62 patients (cases). The current unaided blood ordering method was exactly correct in ordering blood for 27 (43 center dot 5%) of 62 patients (controls). Use of the SBOE resulted in a significantly lower crossmatch-to-transfusion ratio compared to that of the current ordering system (1 center dot 5 vs 2 center dot 3) and saved the hospital transfusion laboratory 465 US$ of crossmatch and inventory management costs in this cohort of patients. Conclusion: The SBOE is a more accurate and cost-saving tool in predicting blood use. It should replace the current unaided method of ordering for perioperative blood in femoral fracture surgery at Mulago Hospital. However, its introduction to other hospitals should be preceded by more rigorous research to strengthen its external validity