Acute Cholecystitis – Current Views

Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and mainly affects those between 40 and 50 years1 and is closely associated with cholelithiasis. It occurs all over the world but Africa is a low risk area as compared to Europe and North America. The disease has been observed in children with ascariasis or those with acquired immune deficiency syndrome (AIDS). The commonest bacteria isolated in acute cholecystitis are E Coli. Clinical presentation includes a raised temperature. Leukocytosis may be absent even in those patients with gangrenous acute cholecystitis. However, Murphy's sign remains very specific. The mainstay of treatment remains surgical either open or laparoscopic cholecystectomy and in high-risk patients percutaneous or open cholecystostomy. Laparoscopic cholecystectomy has greatly increased operating time but reduced hospital stay. The over all mortality has remained 5-12% in the last 2 decades

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 Breast lesions were biopsied and blood withdrawn for HIV sero-survey.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

Knowledge, attitude and practices of staffs towards Post-exposure Prophylaxis for HIV infection at Mulago Hospital in Uganda

The use of anti-human immunodeficiency virus (HIV) drugs after occupational exposure to HIV is a proven method of preventing some HIV infection and there is record that these drugs are being used in treatment of post exposure infection to HIV. This then raises the issues of the impact of such treatment on the staffs. The objective of the study was to asses the level of knowledge attitudes and practices of (PEP) against HIV among surgical staffs. 190 questionnaires were sent to staffs in the department of surgery but One twenty nine (68%) was returned. Questionnaires contained items related to awareness of occupational exposure to HIV and 0.77% had experience of its use in the department and 100% noted that there was no specific policy in relation to PEP in the Surgery Department at mulago Hospital. In relation to attitude staff believe strongly that PEP reduces risks to HIV infection but were also not willing to test for HIV after exposure

Boda-boda injuries a health problem and a burden of disease in Uganda: A tertiary hospital survey

Background: Injury and deaths due to road traffic crashes are a major public health problem in developing countries. Boda bodas (motorcycles) are a practical and a sought after economic activity in Uganda’s capital and cities. The injuries related to boda bodas contribute significantly to the number road traffic injuries seen at Mulago hospitals, taking out significant resources including consumables and the health worker time. This study investigated the pattern of injuries, mortality and estimate cost of care.Methods: A prospective descriptive observational study over a 9 months period was carried out at Mulago Hospital and Complex, Accident and Emergency wards. The Study population was patients involved in Boda Boda related road traffic crushes. Consecutive patients presenting on every 3rd day were selected. Research Ethics committee approval was sought before the study was commenced.Results: A total of 124 patients presented with injuries that warranted at least an overnight stay at the Accident and Emergency ward. Out of the just over 2000 admissions, the majority were males (sex ratio F: M 1:3.5) There was one fatality. Injuries were in 7 categories namely Head, chest, abdominal, pelvic, spinal and soft tissues and extremity fractures. Helmet use in this study was 22%, an improvement from previous nearly zero percent. The estimated cost of care per injured patient was USD 300.Conclusion: Boda Bodas continue to be a major cause or agent of road traffic injuries and a significant economic burden. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws

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

Age at First Child Birth as a Risk Factor of Breast Cancer among Ugandan Women at a Tertiary Hospital: A Case Control Study

Background: Breast Cancer in Uganda is the third commonest cancer in women after cancer of the cervix and Kaposi’s sarcoma. The incidence of Breast Cancer in Uganda has nearly tripled from 1961 to 2006. It has beenconsidered a neglected disease but the reasons to why there is an increase in its incidence have not been fully explained. Studies show that age at first full term child birth has been associated with risk of developing breastcancer in the Caucasian population.Objective: To establish whether age at first full term child birth is  associated with development of breast cancer among Ugandan women.Method: A case control study was conducted over a six months period from November 2011 to April 2012 with patients confirmed with breast cancer as cases and controls without breast cancer. The sampling were convenient and interview questionnaire were administered, and clinical examinations done .The main predictor were age at first full term child birth and the outcome were histologically confirmed breast cancer. Data were analysed using stata 10; using logistic regression models, p-value of less than 0.05 was considered significant.Results: Over all, 183 women were enrolled, (93 cases and 93 controls). The mean age at first full term child birth was 19.8 years. The histological subtype was ductal carcinoma. No association were found between age at first full term child birth and risk of breast cancer adjusted OR 0.3 (0.1-2.4), p=0.239.Conclusion: No associations were found between age at first term child birth and risk for breast cancer disease among this group of Ugandan women.Key words: Breast Cancer, Age at First Birth, Ugand

Gastric cancer diagnosis and treatment guidelines 2008: Uganda Cancer Working Group

In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention. However a better understanding of how it arises (risk factors) will be important in informing prevention and treatment strategies. The Uganda cancer-working group intends that this information is disseminated to wider readership in the region as part of the strategy of improving Oncological care service in the region

Oesophageal cancer management guidelines for Uganda

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Cancer of the breast: 5-year survival in a tertiary hospital in Uganda

The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22–85 years, with a median of 45 years and peak age group of 30–39 years. Twenty-three percent had early disease (stages 0–IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was ‘not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan–Meier) for early disease were 74 and 39% for advanced disease (P=0.001). The overall 5-year survival was 56%, which is lower than the rates in the South African blacks (64%) and North American whites (82–88%)

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc