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

Knowledge about the research and ethics committee at Makerere University, Kampala

Background: All research involving human participants should be reviewed by a competent and independent institutional research and ethics committee. Research conducted at Makerere University College of Health Sciences should be subjected to a rigorous review process by the ethics committee in order to protect human participants’ interests, rights and welfare.Objective: To evaluate researchers’ knowledge about the functions and ethical review process of the College of Health Sciences research and ethics committee.Methods: A cross sectional study. 135 researchers consented to participate in the study, but 70 questionnaires were answered giving a 52% response.Results: Age ranged between 30 to 61 years, majority of participants 30-39 years. Most of the respondents do agree that the REC functions include Protocol review 86%, protection of research participants 84.3%, and monitoring of ongoing research. During ethical review, the RECpays special attention to scientific design [79.7%] and ethical issues [75.3%], but less to the budget and literature review. More than 97% of the respondents believe that the REC is either average or very good, while 2.8% rank it below average.Conclusion: Respondents knew the major functions of the committee including protection of the rights and welfare of research participants, protocol review and monitoring of on going research, and the elements of protocol review that are given more attention include ;scientific design and ethical issues. Overall performance of the REC was ranked as average by respondents. The committee should limit delays in approval and effectively handle all functions of the committee.African Health Sciences 2013; 13(4): 1041 - 104

A rare association of major congenital malformations: a case report

No AbstractKeywords: congenital anomalies, foetus, amelia, ectopia cordis, gastroschisis, syndactyl

Gross Anatomical Variations and Congenital Anomalies of Surgical Importance in Hepatobiliary Surgery in Uganda.

Background: It is important for surgeons to appreciate the possible anatomical variations that can be encountered during surgery. This study was aimed at determining the gross anatomical variations and congenital anomalies of the external hepatobilliary system in Ugandan cadavers and to describe the nature and contents of the gallbladder among cadavers of Ugandans.Methods: This was a cross-sectional study done at the Department of Anatomy Dissection Laboratory at Makerere University Medical School in Kampala, Uganda. The study involved all cadavers dissected in a period of 8 years, from October, 1997 to June 2005, 21 each year, totaling 168 cadavers.Results: A wide range of Anatomical variations of surgical importance were noted among the Ugandan cadavers. In 5% of the cases, the common hepatic artery originated from the superior Mesenteric artery. The course of the cystic artery in 61.9% of the cases was anterior to the right hepatic duct, in 31% it passed anterior to the right hepatic duct, in 8% it lied posterior to the common bile duct, and in 25% of cases, there were more than 2 cystic arteries. In 56% the common hepatic artery branched some 2 – 4cm away from the porta hepatis, 4% branched within the substance of the liver, 19% at the level of porta hepatis while in 5% it branched at the level of right gastric artery. The cystic duct branched off from the common Hepatic duct in 95% of specimens while in 5% originated from the right hepatic duct. Joining of the common hepatic duct contributed to low branching accounting for 67% while 19% had high branching level from the duodenum. The length of the common bile duct ranged from 2.5cm to 12cm, the mode being 4cm and the average 5.1cm. In 4% of the cadavers there were multiple stones with the gallbladder being adherent to neighbouring viscera.Conclusion: The results show that within the Ugandan population, there are marked variations of surgical importance in the gross anatomic features of the hepatobiliary system, which need to be considered to in order to avoid errors during gallbladder or extra hepatic biliary surgery

Practices of Makerere University students during anatomy dissection

Background: The knowledge, skills and practices medical students acquire during grossanatomy dissection are fundamental to the learning of human anatomy and eventual practice of medicine. The changes in the curriculum and the global concerns about how students acquire their anatomical skills and knowledge, made it important to find out what students in our low resource settings do in the anatomy dissection room.Methods : This was a cross-sectional descriptive survey with a qualitative component on two cohorts of 305-second year health professional students on what they do during anatomy dissection practical.Results:The overall response rate was 26.9%. Of the 82 respondents, 35 (42.7%) reported that they only observed the dissection, 25 (31.7%) read the manuals, 20 (24.4%) had actual hands on dissection and one (1.2%) had never dissected. Significantly less male students read the manuals as opposed to doing the hands on dissection (0.18, P=0.0007). The interviews highlighted some of the reasons behind the students preferred roles.Conclusion: The students’ responses highlight differences between institutional expectations of dissection and the actual student practices. Specific roles like reading the manual and dissecting show significant sexual bias. There is a need to examine of the institutional definition of dissection in relation to its low resource settings

Course of the Sciatic Nerve: a review of cases seen at Mulago Hospital, Kampala - Uganda

No Abstrac

Sternal Anomalies with Supernumerary and Subnumerary Vertebrae and Ribs – Case Reports

Background: Variations in the number of ribs and vertebrae have been noted in other wise normal looking people with some having supernumerary while others subnumerary. Sternal variations and anomalies though have not been as widely documented. These are two cases with one having a combination of sternal anomalies, supernumerary thoracic vertebrae and ribs and subnumerary lumbar vertebrae while the other had subnumerary thoracic vertebrae and ribs.Findings: Case 1: A 38year old female who had eleven thoracic vertebrae and corresponding pairs of ribs, nine pairs attached and two floating. The other skeletal components were normal. Case 2: Adult male had 13 thoracic vertebrae and thirteen corresponding pairs of ribs. Ten pairs of ribs attached to the cage and three floating. There were four lumber vertebrae. The manubrium of the sternum was much longer, ended at the third coastal cartilage attachment and there was an oval defect in the body of the sternum at the level of 5th costal cartilage. The rest of the skeleton was normal.Conclusions: Osteological variations in the rib cage and vertebrae are clinically important because they can mislead an unsuspecting clinician during diagnostic and therapeutic lumbar punctures, counting of ribs during heart examinations, drainage of the thorax and the 12th rib is important in citing of the incision for nephrectomy and other medical procedures. Radiological diagnosis, Forensic and medical legal pathological identifications need to put into consideration such variations

Prevalence of child injuries in Mbale region, Eastern Uganda

Background: The rate of unintentional child injuries in sub-Saharan Africa is at 53.1 per 100,000, The highest for low income regions, data on these injuries and associated factors among children in Uganda is very scanty. Most child injuries are related to the way of life in rural communities typically burns from charcoal stoves, candle light , hot fluids, chemicals , falls, and animal bites .Methods: This was a cross sectional community survey among the Promise EBF participants in Mbale district of east Uganda.Objective; to establish the prevalence, causes and associated factors of un intentional child injuries in Mbale District .Results: The commonest unintentional injuries were, falls, and burns 11% of the children. The main causes were hot water (43%) and burning charcoal stoves/firewood. Predisposing factors to burns were residence in rural areas (OR 2.0; 95% CI: 1.1, 3.5) and having three or more siblings (OR 1.6; 95% CI: 0.9, 2.8) .. 40% of the well off mothers and those with at least 8 years of education were more likely to report their child injuries. ((OR: 1.7; 95% CI 1.0, 2.9) and (OR 1.5; 95% CI 1.0, 2.2) respectively).Conclusion: The prevalence of unintentional injuries among children of this cohort of mothers was high, caused by burns, falls, poisoning and animal bites

Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries.

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs