Prevalence, Indications, Levels and Outcome Limb amputations at University Teaching Hospital-Butare in Rwanda

Background: Amputation is one of the oldest surgical procedures with artificial limbs identified from over 2000 years ago. Amputation is still often viewed as a failure of treatment but can be the treatment of choice and life saving procedure for severe trauma, vascular disease and tumors. The aim of this study was to determine the prevalence, indications and levels of limb amputation at the University Teaching Hospital Butare (UTH-B) from 1st January 2009 to 31st March, 2012.Methods: The records of 107 limb amputations performed in patients admitted at UTH-B over a period of 2 years and 3 months were reviewed.Results: Out of 3466 operated cases in Surgery Department, there were 107 limb amputations accounting for 3.08% of all operations performed during the study period. Females accounted for 29.9% cases. The mean age was 44.7±21.5 years. The commonest indication was gangrene in43.95% especially dry gangrene with 22.43%.The most common level was below knew amputation (BKA) with 37.38% of cases. The outcome of the 107 patients amputated: 87.9% had uneventful recovery, 7.5% were re-operated and 4.7% died.Conclusion: The prevalence of limb amputation was 3.08% with the commonest indication as gangrenes most often secondary to peripheral vascular disease. Below knee amputation was the most performed  procedure. The majority (87.9%) of the patients had uneventful recovery. The postoperative mortality rate was 4.7%.Key words: Limb, Amputation, Prevalence, Indications, Levels, outcom

Utilizing the American Board of Surgery in-training exam in a Rwandan surgical residency program: Alignment of exam topics with the University of Rwanda general surgery curriculum

Background: University of Rwanda (UR) increased postgraduate surgery training and assessment strategies are needed. We compared American Board of Surgery In-Training Exam (ABSITE) topics with UR surgery curriculum to determine the applicability of ABSITE in Rwanda.Methods: Topics are outlined in the Surgical Council on Resident Education (SCORE) curriculum whereas the UR utilizes a modular system. Diseases and conditions in SCORE were compared with UR surgery module content. Operation and procedures in SCORE were compared with operative procedures in UR surgery curriculum.Results: Overall, 72% of diseases and conditions from SCORE were covered in UR curriculum. Of this, 76% of medical knowledge and 71% of patient care content was covered in UR curriculum. 41% of operations and procedures from SCORE were identified in UR curriculum. 55% of core operations and 16% of advanced operations from SCORE were included in UR general surgery curriculum. Content identified in UR curriculum and not SCORE included infectious and tropical diseases, orthopedics, urology and neurosurgery.Conclusions: There is alignment between ABSITE topics and UR general surgery curriculum suggesting that the ABSITE can be used as an in-training examination for Rwandan residents. Understanding the limitations of the ABSITE exam can help utilization of this examination.Keywords: internship and residency, curriculum, Rwanda, global healt

A Comparison of Kampala Trauma Score II with the New Injury Severity Score in Mbarara University Teaching Hospital in Uganda

Background: Road traffic injury is of growing public health importance because of its significant contribution to the global disease burden. The need to predict outcome of injuries has led to the development of injury scores. The Kampala Trauma Score II (KTSII) now recommended for use in resource-poor settings, has not been compared with, the New Injury Severity Score (NISS) preferred by many authors. We compared the performance, predictive power, sensitivity, and specificity in predicting mortality at two weeks of the KTSII and NISS in patients involved in road traffic accidents seen on the surgical ward at Mbarara Regional Referral Hospital (MRRH).Methods: This prospective study conducted between June 2005 and August 2006, examined clinical and radiological data of 173 consecutive patients admitted to the emergency surgical ward at Mbarara Regional Referral Hospital with road traffic injuries. Only patients presenting within 24 hours of injury and with 3 or more injuries were recruited in the study. The KTS II and NISS scores were computed for each patient on admission. The primary outcome measure was survival. Receiver Operating Characteristics (ROC) analysis, and logistic regression analysis were used for comparison.Results: The KTSII predicted mortality and discharge with AUC of 0.87 (NISS, AUC 0.89). The KTSII was less accurate (AUC 0.65) than the NISS (AUC 0.83) in predicting long stay in the hospital. At cut off point of 9 and below, the KTSII had sensitivity of 87% and specificity of 81% while the NISS had 96% and 78.4% respectively in predicting mortality. The KTS II predicted long hospital stay at cut off score of 9 and below, with sensitivity of 87.5% and specificity of 81%.Conclusions: The KTSII is as reliable a predictive score as is the NISS. This study demonstrated that the KTS II provides reliable objective criterion upon which injured patients can be triaged in emergency care conditions. The KTS II may enhance the use of ambulance services and timely transfer of the injured and its use in trauma management should be further encouraged in resource-poor settings. In addition, the KTS II will make the documentation of the epidemiology of trauma more feasible in resource-poor settings

Scaling up a surgical residency program in Rwanda

Background: Beginning in 2012, the Government of Rwanda implemented the Human Resources for Health (HRH) program to enhance capacity building in the Rwandan health education sector. Through this program, surgical training at University of Rwanda (UR) has expanded. The aim of this presentation is to describe the scaling up of the UR surgical residency programMethods: We performed a descriptive analysis of the UR surgical residency program after initiation of the Rwanda HRH Program.Results: Through the HRH Program, faculty from US institutions supplements the existing Rwandan educational infrastructure to increase the teaching capacity in Rwanda. Intake of surgical trainees more than doubled within the first year of the program. Service-based surgical training has changed to competency-based training through curriculum development, dedicated academic days and surgical education within firms. Lectures remain a dominant feature of the educational program, but more focus is placed on bedside teaching and peer-education. Shortage of operative space and a tremendous number of emergency patients overwhelm public teaching hospitals posing a challenge towards providing residents with a broad spectrum of operative experiences, especially elective surgical cases.Conclusion: Through this program, the ursurgical residency program has greatly expanded. Over time, the quantity and quality of surgical residents is expected to increase

Abdominal injury at Mbarara Regional Referral Hospital, Uganda

Background: Trauma poses a major public health challenge in Africa. This study was aimed at determining the prevalence, patterns and predisposing factors of abdominal injury in Mbarara Regional Referral Hospital (MRRH).Methods: A standard questionnaire was used to record the patterns, type and predisposing factors of injuries. All patients admitted to Mbarara Regional Referral Hospital (MRRH) with a diagnosis of abdominal injury over the study period made the study population.Results: Abdominal trauma accounted for 14.23% of the 836 trauma admissions seen over the study period. Fifty two percent of the injuries had been sustained on the road. Males were five times more than females and the age range was 3-88 years, with a mode of 27 years. Blunt trauma accounted for 85.71% of abdominal injury, the spleen was injured in 43.7% and fractures were associated in 27.7%. Most patients (68.9 %) were managed nonoperatively.Conclusion: Blunt abdominal injury was the commonest pattern of injury (85.7%). Abdominal trauma is a common emergency at Mbarara Regional Referral Hospital accounting for 14.23% of admissions due to injury. Most injuries are a result of road traffic crushes (47.1%) and assault. Alcohol consumption is a major predisposing factor. Peasants are more predisposed to abdominal injuries. Non-operative management of hemoperitoneum is safe in hemodynamically stable patients

Dyspepsia prevalence and impact on quality of life among Rwandan healthcare workers: A cross-sectional survey

Background. Dyspepsia has been demonstrated worldwide to have major personal and societal  impacts, but data on the burden of this disease in Africa are lacking.Objective. To document the prevalence of dyspepsia and its quality-of-life impact among healthcare  workers (HCWs) at Butare University Teaching Hospital (BUTH), Rwanda.Methods. A cross-sectional survey among consenting HCWs at BUTH was conducted. Multilingual  interviewers guided participants through validated questionnaires, including the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), to detect the presence and frequency of dyspeptic symptoms, and the Short-Form Nepean Dyspepsia Index (SF-NDI), to examine the impact of dyspepsia on quality of life.Results. The study included 378 enrolled HCWs, all of whom provided responses to the SF-LDQ and 356 of whom responded to the SF-NDI. The prevalence of dyspepsia in the study population was 38.9% (147/378). Of these 147 HCWs, 79 (53.7%) had very mild dyspepsia, 33 (22.4%) had mild dyspepsia, 20 (13.6%) had moderate dyspepsia and 15 (10.2%) had severe dyspepsia. Females were more likely to complain of dyspepsia than males (98/206 v. 49/172; odds ratio (OR) 2.3; 95% confidence interval (CI) 1.5 - 3.5; p<0.001). Participants with dyspepsia of at least mild severity had SF-NDI scores reflecting reduced quality of life when compared with non-dyspeptic participants (OR 17.0; 95% CI 5.0 - 57.1; p<0.001), with most marked effects on the ‘tension’ and ‘eating and drinking’ subdomains of theSF-NDI.Conclusion. The prevalence of dyspepsia among HCWs in Rwanda is high and is associated with lowered quality of life

Chronic subdural haematoma complicating spinal anaesthesia: A case report and review of literature

Subdural haematoma is a rare but serious complication of dural puncture. We report a case of chronic subdural haematoma, which occurred following spinal anaesthesia for elective caesarean section. A 34-year-old multiparous woman presented with a post-dural puncture headache (PDPH) following spinal anaesthesia. The headache was nonresponsive to analgesics, bed rest and rehydration. CT-scan was done and showed a large right fronto-parietal subdural hematoma. This was drained successfully with complete recovery. Prolonged and severe post-dural puncture headache may be the only clinical indicator of post-spinal anaesthesia intracranial complications, and should be promptly investigated

Influence of spectral properties on cassava leaf development and metabolism

Cassava’s importance as a food security crop in Sub Saharan Africa will be enhanced by its special traits such as tolerance to drought and high yields under hydrothermal stress. Some of the special traits which include the light reflective and absorptive properties of the leaves that depend on the surface characteristics of the leaves, are variety dependent and may influence the plants’ reaction to light; hence, its photosynthetic capacity. We investigated the differences in the leaf spectral properties in different cassava varieties and related them to leaf biochemical properties using 20 cassava varieties established in a randomized complete block design in Kasese, western Uganda. Time dependent changes in leaf spectral characteristics were studied using Digimizer software and related to changes in sugar and pigment properties. Changes in the amount of reflected light were observed for the three main wavelengths used by plants (blue, green and red) with the blue being the most preferred. Total soluble free sugars exhibited a diurnal pattern from lower values (0.07 mg/g) after the dark period to higher values (0.313 mg/g) as the day progressed and was different from those of translocatable sugars such as sucrose. Chlorophyll a exhibited a curved pattern in all varieties increasing with increase in light intensity from 09:00 h (0.18 ug/g), peaking at 15:00 h (0.22 ug/g) and dropping down in concentration by 18:00 h (0.16 ug/g). Significant differences were observed in cassava varieties for the concentration of chlorophylls and carotenes. The results were obtained at a time of optimal growth conditions (four months after planting) and were used to classify these varieties into three broad groups showing that studies on spectral properties of leaves can still give a lot of insights in selection for stress tolerance under less optimal stress. The significant changes observed in the phenotype especially the foliar portion of the plant with the stay green and early recovering mechanisms of tolerance identified also tarried well with observed spectral differences. The results show that studies on plant spectral properties can be important in making inferences on the plants physiological and growth status.Keywords: Spectral properties, tolerance mechanisms, physiology, reflectance

HERITABILITY ANALYSIS OF PUTATIVE DROUGHT ADAPTATION TRAITS IN SWEETPOTATO

Drought stress is a constraint to sweetpotato ( Ipomoea batatas L. (Lam)) production in many parts of Sub-Saharan Africa. In this region, crop farming is predominantly rain fed; therefore, breeding for drought tolerance is appropriate for addressing low sweetpotato productivity since the crop is largely produced by resource-limited farmers. As part of developing drought tolerant genotypes in Uganda, this study aimed at determining the nature of genetic control and heritability associated with selected drought adaptation traits. Ten randomly chosen clones from each family were evaluated for three traits; tuber yield, crop vigour and canopy cover as well as five traits (leaf senescence, leaf rolling, leaf retention, SPAD readings and root vertical pulling) at 80% field capacity and under no watering conditions for three weeks in a glasshouse. Diallel analysis revealed significant effects for both GCA and SCA, indicating both additive and non-additive gene actions were present. Baker\u2019s ratio was large in most traits (>0.50), indicating predominance of additive effects. Heritability coefficients were high in most traits (>0.50), indicating that genetic gains can be achieved by conventional breeding. The predominance of additive genetic control realised in this study implies that use of small numbers of parents with suitable GCA effects is most appropriate for drought tolerance improvement in sweetpotato.La s\ue9cheresse constitue une contrainte importante \ue0 la production de la patate douce ( Ipomoea batatas L. (Lam)) dans beaucoup de parties de l\u2019Afrique sub Saharienne. Dans cette r\ue9gion, l\u2019agriculture est \ue0 predominance pluviale, ainsi, l\u2019am\ue9lioration pour la tol\ue9rance \ue0 la s\ue9cheresse est appropri\ue9e pour adresser la faible productivit\ue9 de la patate douce d\u2019autant plus que la culture est largement produite par les fermiers \ue0 resources limit\ue9es. Comme contribution au d\ue9veloppement des genotypes tolerant la s\ue9cheresse en Ouganda, cette \ue9tude a pour but de d\ue9terminer la nature de l\u2019heritabili\ue9 et le contr\uf4le g\ue9n\ue9tique associ\ue9s aux traits d\u2019adaptation \ue0 la s\ue9cheresse. En suite, dix clones al\ue9atoirement choisis dans chaque famille \ue9taient \ue9valu\ue9s au champs pendant dix huit semaines pour trois traits dont le rendement en tubercules, la vigueur de la plante et la couverture de la canop\ue9e ainsi que cinq traits (la senescence foliaire, l\u2019enroulement de la feuille, la retention foliaire, ls lectures du SPAD et l\u2019attrait de la racine verticale) \ue0 80% de la capacit\ue9 au champ et sans r\ue9gime de conditions d\u2019arrosage pendant trois semaines dans une serre). L\u2019analyse Diall\ue8le a r\ue9v\ue9l\ue9 des effets significatifs pour le GCA et SCA, indicant la pr\ue9sence des actions additives et non additives de g\ue8nes. Le rapport de Baker \ue9tait large dans laplupart des traits (>0.50), indicant la pr\ue9dominance des effets addidifs. Les coefficients d\u2019heritabilit\ue9 \ue9taient \ue9lev\ue9s dans la plupart des traits (>0.50), montrant que des gains g\ue9n\ue9tiques peuvent \ueatre acquis par l\u2019am\ue9lioration conventionnelle. La pr\ue9dominance du contr\uf4le g\ue9n\ue9tique additif r\ue9alis\ue9 dans cette \ue9tude implique que l\u2019utilisation d\u2019un petit nombre de parents avec effets GCA appropri\ue9s est la plus indiqu\ue9e pour l\u2019am\ue9lioration de la tol\ue9rance \ue0 la s\ue9cheresse dans la patate douce

Portable PCR field-based detection of sweetpotato viruses

Sweetpotato ( Ipomoea batatas Lam.) production is greatly constrained by viral infections, especially Sweet potato feathery mottle virus and Sweet potato chlorotic stunt virus that synergistically cause a severe sweetpotato virus disease. The impact of viruses is aggravated by the vegetative nature of the crop and inaccessibility to dependable diagnostic tools in rural areas where sweetpotato production is done. This makes it hard for seed inspectors to perform quality checks prior to use of vines for planting. The objective of this study was to develop a procedure that allows for detection of sweetpotato viruses on-site. This involved modification of the Lodhi et al. (1994) nucleic acid extraction procedure, by omitting some of the laboratory specific steps and varying the incubation time in liquid nitrogen, instead of the freezer. Incubation in liquid nitrogen for only 1.5 hours yielded as high quality RNA compared to that of the original protocol, when incubation was done at 4\ub0C overnight in a freezer. Reverse transcriptase (RT) was run using a portable miniPCR thermocycler; and the resulting cDNA was amplified using this miniPCR machine instead of using a laboratory stationed conventional PCR thermocycler. The cDNA was efficiently amplified and amplicons were similar to those obtained with the original extraction protocol and subsequent amplification by the conventional RT-PCR. Our protocol reduced extraction time from about 16 hours for the original protocol, to about 2 hours and 45 minutes. If this tool is utilised by the crop protection departments, we believe it will contribute greatly towards sustainable sweetpotato production through making timely recommendations.La production de la patate douce ( Ipomoea batatas Lam.) est fortement limit\ue9e par les infections virales, en particulier le virus de la marbrure plumeuse de la patate douce et le virus du stunt chlorotique de la patate douce qui provoquent en synergie une maladie virale grave de la patate douce. L\u2019impact des virus est aggrav\ue9 par la nature v\ue9g\ue9tative de la culture et l\u2019inaccessibilit\ue9 des outils fiables pour le diagnostic dans les zones rurales o\uf9 la production de patate douce est r\ue9alis\ue9e. Cela rend difficile les inspecteurs des semences d\u2019effectuer des contr\uf4les de qualit\ue9 avant l\u2019utilisation des vignes par les agriculteurs. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9velopper une proc\ue9dure permettant la d\ue9tection des virus de la patate douce sur place. Cela impliquait une modification de Lodhi et al. (1994) proc\ue9dure d\u2019extraction d\u2019acide nucl\ue9ique, en omettant certaines des \ue9tapes sp\ue9cifiques du laboratoire et en faisant la variation de temps d\u2019incubation dans l\u2019azote liquide, au lieu du cong\ue9lateur. L\u2019incubation dans l\u2019azote liquide pendant seulement 1,5 heure a donn\ue9 un ARN de haute qualit\ue9 comme le protocole d\u2019origine, lorsque l\u2019incubation a \ue9t\ue9 effectu\ue9e \ue0 4 \ub0 C pendant une nuit dans un cong\ue9lateur. La transcriptase inverse (RT) a \ue9t\ue9 faite en utilisant un thermocycleur mini PCR portable et l\u2019ADNc, et r\ue9sultant a \ue9t\ue9 amplifi\ue9 en utilisant cette machine mini PCR au lieu d\u2019utiliser un thermocycleur PCR conventionnel stationn\ue9 en laboratoire. L\u2019ADNc a \ue9t\ue9 efficacement amplifi\ue9 et les amplicons \ue9taient similaires \ue0 ceux obtenus avec le protocole d\u2019extraction original et l\u2019amplification ult\ue9rieure par la RT-PCR conventionnelle. Notre protocole a r\ue9duit le temps d\u2019extraction d\u2019environ 16 heures pour le protocole d\u2019origine, \ue0 environ 2 heures et 45 minutes. Si cet outil est utilis\ue9 par le d\ue9partement de la protection des cultures, nous pensons qu\u2019il contribuera grandement \ue0 la production durable de patate douce en faisant des recommandations en temps opportun