Mural endocarditis - by default

We report on a case of a 33-year-old female patient with known adult congenital heart disease in the form of a coronary cameral fistula who, on prior presentation, had refused treatment and subsequently defaulted follow-up, but unfortunately developed a serious and rare complication. She presented with non-specific neurological symptoms of transient visual loss and headaches. Clinical examination revealed aortic regurgitation with peripheral features of infective endocarditis. This was confirmed with transthoracic echocardiogram, but additionally, we found mural endocarditis of the right atrial posterior wall. An initial CT brain scan and ophthalmology assessments were negative, blood cultures were positive and confirmed infective endocarditis, and she was referred for urgent cardiothoracic surgery. Unfortunately, she had further complications with a large intracranial haemorrhage which ultimately led to her death. This case illustrates a rare entity with disastrous complications

Pediatric Cerebral Palsy in Africa: Where Are We?

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular therapy input. Relevant guidelines are lacking. In order to guide services for children with existing disabilities, to effectively target the main etiologies and to develop preventive strategies for the continent, research priorities must include multicenter collaborative studies looking at the prevalence, risk factors, and treatment of cerebral palsy

A gentle push towards improved hygiene and food safety through ‘nudge’ interventions

Most of the perishable food in low- and middle-income countries is sold in informal markets where food handlers are not usually trained in good hygienic practices. There are different approaches to improve food safety in those markets, some of which include capacity building. However, one-off trainings are not usually sustainable as behaviours are deeply rooted and often lead to unconscious practices that can increase risk of food contamination. Close follow-up is intense in terms of human and financial resources. Nudges have been described to influence behaviour with varying results, partly depending on whether they have been imposed on or co-created with the end-users. In this study we describe the human-centred-design process from identifying critical control points between slaughter and retail to co-creating nudges that could potentially lead to better compliance of meat handlers in Uganda with good hygienic practices. Three of the WHO “Five Keys To Safer Food” were selected as the target behaviours to improve. The qualitative research was implemented in the greater Kampala area between October 2020 to December 2021 and involved 119 meat handlers, pork joint customers, food safety and veterinary technical experts and over 20 project stakeholders. Findings from the initial ‘explore’ phase generated a number of insights on meat handlers’ perceptions and attitudes that were later used to generate ideas and solutions in cocreating nudges during the ‘experiment’ phase: 1) Meat handlers eat the pork they handle at work and have low risk perception; 2) Meat handlers feel their practices are acceptable; 3) Meat handlers see ‘broken windows’ which set the norm for unhygienic behaviour; 4) Meat handlers follow the path of least resistance; 5) Meat handlers keep up appearances for customers; and 6) Owners want to see returns on hygienic investments. Fourty-two early prototypes were co-created with potential end users and after several iterations, two nudge kits emerged, e.g. the “Keep Clean Loop” and the “Tricolour Kitchen”. In a subsequent pilot test we assessed if the nudges help reducing the burden of foodborne pathogens and if behaviour of meat handlers changes sustainably

Treatment of seizures in the neonate: Guidelines and consensus-based recommendations—Special report from the ILAE Task Force on Neonatal Seizures

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). If insufficient evidence was available, then expert opinion was sought using Delphi consensus methodology. The strength of recommendations was defined according to the ILAE Clinical Practice Guidelines development tool. There were six main recommendations. First, phenobarbital should be the first-line ASM (evidence-based recommendation) regardless of etiology (expert agreement), unless channelopathy is likely the cause for seizures (e.g., due to family history), in which case phenytoin or carbamazepine should be used. Second, among neonates with seizures not responding to first-line ASM, phenytoin, levetiracetam, midazolam, or lidocaine may be used as a second-line ASM (expert agreement). In neonates with cardiac disorders, levetiracetam may be the preferred second-line ASM (expert agreement). Third, following cessation of acute provoked seizures without evidence for neonatal-onset epilepsy, ASMs should be discontinued before discharge home, regardless of magnetic resonance imaging or electroencephalographic findings (expert agreement). Fourth, therapeutic hypothermia may reduce seizure burden in neonates with hypoxic–ischemic encephalopathy (evidence-based recommendation). Fifth, treating neonatal seizures (including electrographic-only seizures) to achieve a lower seizure burden may be associated with improved outcome (expert agreement). Sixth, a trial of pyridoxine may be attempted in neonates presenting with clinical features of vitamin B6-dependent epilepsy and seizures unresponsive to second-line ASM (expert agreement). Additional considerations include a standardized pathway for the management of neonatal seizures in each neonatal unit and informing parents/guardians about the diagnosis of seizures and initial treatment options

Study of taxation, registration, legal and regulatory issues affecting small businesses in Uganda & Pounder Rig contractor business: projected cash flow

This document is made up of a number of reports. The first section contains a study of ‘Taxation, Registration, Legal and Regulatory Issues Affecting Small Business in Uganda’, by Kakooza, Ball and Da