Outcome of paediatric supracondylar humeral fractures treated by surgery at the University Teaching Hospital of Kigali, Rwanda

Background: Supracondylar humeral fractures are common elbow injuries in children. When these fractures are managed improperly, patients end up having complications that interfere with daily activities. Objective: This study was conducted to evaluate the functional outcome of supracondylar humeral fractures treated with surgery at the University Teaching Hospital of Kigali, Rwanda. Methodology: This was a combined retrospective and cross-sectional observational study. The sample size was 108. Theatre logs and OPD files were used to obtain patients' clinical information. Functional outcome was evaluated using QuickDASH score. Results: Children having 6 to 10 years of age were predominant (54.6%). Male to female ratio was 1.9:1. The left elbow was most affected (60.2%). Seventy five patients (69.4%) were within normal range, 27 (25.0%) patients had mild disability, 5 (4.7%) patients had moderate disability, and 1 (0.9%) patient had severe disability. There were no patients with very severe disability. The most common complication was elbow stiffness (59.3%), followed by gunstock deformity (27.1%). The only determinant of functional outcome found was the time (within 4 days or beyond) from injury to management (OR: 0.993, 95% CI: {0.987-1.000}, p-value: 0.048). Conclusion: For operable supracondylar humeral fractures in children, operation within 4 days and good follow up of patients in postoperative period are crucial for good functional outcome

Predictors of molecular subtypes in women with breast cancer in Rwanda

INTRODUCTION: Breast cancer (BC) constitutes a major public health problem worldwide. It remains a major scientific, clinical and societal challenge, generally in Africa and particularly in Rwanda. The purpose of this study was to determine clinical and histopathological predictors of BC molecular subtypes in Rwandan women. METHODS: A retrospective cohort study including patients with histological confirmation of BC. Using R statistical software, a regression model for multinomial responses was developed. Univariate and multivariate logistic regression analyses were used to identify independent BC molecular subtypes predictors. A two-sided p<0.05 indicated a statistically significant difference. RESULTS: Forty seven percent of cases presented with advanced stages (Stage III and IV). Postmenopausal BC (p=0.0142), absence of infertility (p=0.018) predicted Luminal A subtype with a predictive accuracy of 0.65. Age (p=0.003), postmenopausal BC (p=0.005), absence of axillar lymph nodes (p= 0.008) and poorly differentiated tumor (p=0.012) were predictors for Luminal B subtype with a predictive accuracy of 0.86. Age (p=0.045), BMI (p=0.005), rapid progression (p=0.032), tumor size T2-T3 (p<0.001) were predictors of HER2-Enriched subtype with a predictive accuracy of 0.70. Age below 40 (p=0.005), painless mass (p=0.030), nodal involvement (p=0.008), Nottingham grade 3 (p<0.001) predicted Triple Negative tumors with a predictive accuracy of 0.71. CONCLUSION: Clinical and histopathological tumor characteristics can be used to predict BC molecular subtypes with acceptable accuracy. Further studies are needed to explore the possibility of developing a scoring system for clinical decision-making, especially in settings where immunohistochemistry testing is limited

Agricultural sustainability in developing countries: an assessment of the relationships between drivers and indicators in Hoa Binh Province, Vietnam

Indicator-based methods have been extensively used to assess agricultural sustainability. Their main weakness has been a focus on the outcomes, revealing little about the causes of these outcomes because drivers of sustainability, and interactions among indicators and drivers, are not explicitly addressed. This makes it difficult to identify systemic policy levers and potential unintended consequences of policies. Our research took a systemic approach to sustainability assessment and explored relationships between indicators and drivers within the small scale farming systems of Hoa Binh Province, Vietnam. Our results highlight rather poor sustainability performance. Crop yield and net farm income were low. Food self-sufficiency was a problem. Households were dependent on high rates of chemical fertilizers and pesticides while pest and disease occurrence was reportedly increasing. Irrigation water shortages were also an issue. We also found many interrelationships among drivers and indicators of agricultural sustainability. Household location, education level, labor availability, and ethnic minority membership were highly connected drivers that influenced several other drivers and indicators directly or indirectly. Policies targeted at these are likely to have broad systemic effects on sustainability performance. However, due to the connected nature of the system, there is potential for unintended consequences from well-intended policies