CHALLENGES ASSOCIATED WITH MANAGEMENT OF TYPE 2 MELLITUS AMONG ADULTS AGED 45-60 YEARS ATTENDING DIABETIC CLINIC AT KISENYI HEALTH CENTRE IV IN KAMPALA DISTRICT. A DESCRIPTIVE CROSS-SECTIONAL STUDY DESIGN.

Background: Type 2 diabetes mellitus is a type of diabetes mellitus that is very prevalent in Uganda and affects a wide percentage of the adult population. Much as there have been successive interventions in the prevention and control of this non-communicable disease, it is still increasing annually. Methodology: This was a descriptive cross-sectional study conducted to assess the challenges associated with the management of type 2 diabetes mellitus among adults aged 45-60years attending the diabetic clinic at Kisenyi Health Centre IV and the researchers ought to determine the knowledge, lifestyle factors, and health facility-related factors associated with the management of type2 diabetes mellitus among the same population. Results: Study findings revealed that males were the majority65% and stayed in a rural residence 69%. Most of the respondents had sufficient knowledge of diabetes mellitus. More than 80%had knowledge of the definition, types, signs, and causes of diabetes. The majority of respondents said there was a general readiness of facilities to handle diabetes but the health workers needed more training. Conclusion: In conclusion, the respondents had sufficient knowledge of diabetes mellitus. Most of the diabetics could define diabetes and knew at least two causes of diabetes mellitus though most thought that taking too much sugar was the most likely cause. The respondents know the types of diabetes mellitus, its signs and symptoms, and the susceptible ages of diabetes mellitus. Recommendations: There is a need for the government to therefore prioritize the non-communicable disease treatment and prevention budget, for the health facilities to develop better organizational structures in diabetic clinics and proper stock management. All these will help to reduce the diabetes disease burden in the country at large

Barriers and Facilitators to the Integration of Mental Health Services into Primary Health Care: A Systematic Review Protocol.

Background Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. Methods This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the “Best fit” framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. Discussion The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the “Best fit” framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. Systematic review registration PROSPERO CRD4201605200

Symmetrical peripheral gangrene following testicular torsion surgery: A case report

Key Clinical Message Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It is almost always associated with septicemia and has a high mortality rate. The rarity of this condition and lack of prospective trials makes its recognition and management difficult. Care providers should maintain a high index of suspicion for SPG in patients with sepsis who develop cyanosis and ischemia of extremities. Doing early culture and sensitivity studies is key in guiding apropriate antibiotic treatment. Abstract Symmetrical peripheral gangrene (SPG) is very rare condition associated with symmetrical ischemia and gangrene affecting two or more distal extremities. It can occur at any age and may affect either sex. It is almost always associated with septicemia and has a high mortality rate (up to 35%). The rarity of this condition and lack of prospective trials makes its recognition and management difficulty. Only a few case reports have been in literature since its discovery in 1981. A 14 year old boy was referred to our tertiary facility due to postoperative wound sepsis. He had undergone right scrotal exploration and orchidectomy due to right testicular torsion. His initial symptoms were abrupt onset of scrotal pain and swelling which he developed while playing. Physical examination findings on admission were severe pallor of mucous membranes, fever and diaphoresis and mild respiratory distress. He also had a gangrenous perineal area involving the penis and cyanosed tips of fingers and toes bilaterally. He had a normal ankle branchial index of 0.9. His preliminary laboratory investigations revealed a marked neutrophilia, anemia, thrombocytopenia, and elevated D‐Dimers. Initial resuscitative interventions included oxygen therapy, blood transfusion with whole blood and platelets, empirical antibiotics, analgesics, and surgical debridement of the perineal in theater. A diagnosis of severe sepsis complicated with disseminated intravascular coagulation (DIC) was made. The cyanosis on extremities spread proximally during the patient's course of treatment to full blown gangrene. At the time when clinical and biochemical remission of the infection was attained, the gangrene had demarcated at below elbow in both upper limbs and below knees in both lower limbs. An arterial angiogram was done and revealed normal flow in all proximal and distal branches of the aorta with no occlusion. A multidisciplinary agreement to conduct quadrilateral amputations plus penile amputation was made between urologists, vascular and orthopedic surgeons. The exact pathogenesis of how SPG occurs is not well understood. The underlying mechanism includes a low flow state with DIC. Ischemic changes usually begin in the peripheries and extend proximally. Ischemic changes are not preceded by peripheral vascular occlusive disease. SPG should be suspected when a patient present with marked coldness, pain in the distal extremities, cyanosis, and pallor. Early recognition helps to arrest the progression of ischemic changes before overt gangrene occur and improves the qaulity of life

Anatomical variation and distribution of the vagus nerve in the esophageal hiatus: a cross-sectional study of post-mortem cases in Uganda

Purpose Vagus nerve injuries during gastroesophageal surgery may cause significant symptoms due to loss of vagal anti-inflammatory and neuromodulator function. Many previous studies have shown high anatomical variability of the vagus nerve at the esophageal hiatus, but information on its variability in Uganda specifically and Africa in general is scanty. This study provides a reliable and detailed description of the anatomical variation and distribution of the vagus nerve in the esophageal hiatus region of post-mortem cases in Uganda. Methods This was an analytical cross-sectional survey of 67 unclaimed post-mortem cases. Data collection used a pretested data collection form. Data were entered into Epi-Info version 6.0 data base then exported into STATA software 13.0 for analysis. Results The pattern of the anterior vagal trunk structures at the esophageal hiatus was: single trunk [65.7%]; biplexus [20.9%]; triplexus [8.9%] and double-but-not-connected trunks [4.5%]. The pattern of the posterior trunk structures were: single trunk [85.1%]; biplexus 10.4% and triplexus [4.5%]. There was no statistically significant gender difference in the pattern of vagal fibres. There was no major differences in the pattern from comparable British studies. Conclusion The study confirmed high variability in the distribution of the vagus nerve at the esophageal hiatus, unrelated to gender differences. Surgeons must consider and identify variants of vagal innervation when carrying out surgery at the gastroesophageal junction to avoid accidental vagal injuries. Published surgical techniques for preserving vagal function are valid in Ugand

Knowledge and Practices of Self-Care among People with Diabetes in South Western Uganda: A Cross-Sectional Study at a Regional Referral Hospital in Mbarara City.: Diabetes self-care knowledge and practice in Mbarara city.

Background:  Diabetes is a chronic metabolic disease with increasing prevalence globally. Glycemic control is the ultimate management goal possible through self-care activities predominantly patient-driven and enhanced by one’s knowledge. These consequently minimize associated adverse complications hence maintaining the quality of life among people with diabetes. Self-care knowledge and practice are globally found unsatisfying to control glycemia among many diabetic populations. There is a critical need to assess current knowledge and practice regarding self-care among diabetic people to control their diabetes. Methods:  We conducted a hospital-based cross-sectional study on 228 participants who were living with diabetes for at least six months since diagnosis. A standard tool, adopted and modified to suit the setting was used; the self-report Diabetic Knowledge Test Questionnaire for self-care knowledge and a revised version of the Summary Diabetes Self-Care Activities Questionnaire for practice. Both descriptive and logistic analysis was done using Stata software, version 13. Results:  Adequate diabetes self-care knowledge was average (56%) and adequate self-care practice was below average (35%). Major gaps in foot care, blood glucose testing, hypoglycemia recognition, and management. Multiple logistic regression revealed longer duration with diabetes and more frequency of receiving health education highly associated with adequate self-care knowledge and practice (duration ≥ 11 years, AOR: 2.9; P=0.014) and health education on every clinic visit (AOR: 4.0; P=0.005) for self-care knowledge while duration ≥ 6 years (AOR=3.3, P-value = 0.011) and health education twice from the time they started clinic visits (AOR= 0.2, P= 0.048) for self-care practice.     Conclusion:  Interventions should be developed focusing on precise and user-friendly health education packages translated to local languages, and eye-catching to the audience, priority to newly diagnosed and less educated. A further study assessing appropriate health education delivery avenues to clients of various characteristics, especially rural communities

Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda—A Quantitative Cross-Sectional Study

The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers

Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol

Abstract Background Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. Methods This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the “Best fit” framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. Discussion The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the “Best fit” framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. Systematic review registration PROSPERO CRD4201605200

Renovation of marketplace Tabor in Maribor

Projektna naloga obravnava območje tržnice Tabor v mestni četrti Nova vas. V prvem delu naloge je predstavljena mestna četrt Nova vas in njene spremembe skozi čas. Temu sledijo referenčni primeri in analiza obravnavanega območja z idejno zasnovo. Predstavljena je idejna zasnova prenove tržnice z ureditvijo javnih odprtih površin, dostopov za napajanje programov in funkcionalno ovirane ter zasnova kavarne.The project deals with the area of the marketplace Tabor in the city district Nova vas. The first part of the project presents the city district Nova vas and its changes through time, then follow some examples and the analysis of the marketplace with its concept. The project also includes the concept of renovating the marketplace with the arrangements of open public spaces, access to the additional programs, a cafeteria and access for the disabled

Neural stem cell research in Africa: current realities and future prospects

Neural stem cells (NSCs) are immature progenitor cells that are found in developing and adult brains that have the potential of dividing actively and renewing themselves, with a complex form of gene expression. The generation of new brain cells in adult individuals was initially considered impossible, however, the landmark discovery of human neural stem cells in the hippocampus has been followed by further discoveries in other discreet regions of the brain. Investigation into the current state in Africa of the research and use of NSCs shows relatively limited activities on the continent. Information on the African application of NSCs for modelling disease mechanisms, drug discovery, and therapeutics is still limited. The International Brain Research Organization (IBRO)-African Regional Committee (ARC), with support from the Company of Biologists, and the Movement Disorder Society, sponsored the first African Basic School on NSC in Ibadan, Nigeria, with the vision of bringing together young neuroscientists and physicians across different fields in neuroscience to learn from leaders who have applied NSCs in stem cell research, the pathophysiology of neurodegenerative diseases, neuroanatomy, and neurotherapeutics. Twenty early-career researchers in academic institutions at junior and senior faculty cadres were selected from South Africa, Uganda and Nigeria. The students and organizer of the school, who wrote this review on the state of NSCs research in Africa, recommended the following: (1) other African countries can take a cue from South Africa and Nigeria in probing the phenomena of adult neurogenesis in unique animal species on the continent; (2) Africa should leverage the expertise and facilities of South African scientists and international collaborators in scaling up NSC research into these unique species and (3) Centers of Excellence should be established on the continent to serve as research hubs for training postgraduate students, and facilities for African scientists who trained overseas on NSCs