Student self-assessment after Essential Surgical Skills training for final-year medical students at Gulu University, northern Uganda

Background: Medical practice depends on a set of essential clinical and surgical skills, yet inadequate attention is given to training these skills in medical school. This study aimed to evaluate the effect of Essential Surgical Skills® (ESS) training on self-report comfort levels in performing surgical skills among final-year medical students at Gulu University in Gulu, Uganda. Methods: This study analysed 5 years’ worth of pre- and post-course ESS self-evaluation questionnaires completed by final-year medical students attending Gulu University between 2013 and 2017. Pre- and post-course results were compared using Student’s t-test. ESS elements covered over the 5-day course were: surgery fundamentals; respiratory and anaesthesia skills; and skills related to gastrointestinal, obstetric, and orthopaedic surgery. Results: There was a significant improvement in the students’ level of comfort related to all ESS components when pre- and post-course questionnaire responses were compared (P < 0.001). Conclusions: Medical schools should emphasize training of essential clinical and surgical skills because these give medical students the confidence and proficiency needed in clinical practice. Keywords: surgical skills; education; training; medical school; Uganda; Somalia

Delay of emergency surgical interventions in Ethiopia: Patient and health system factors

Background: The objectives of this study were to evaluate outcomes among patients with acute abdomen and abdominal trauma who presented at either of 2 referral hospitals in Addis Ababa, Ethiopia, and to determine the factors associated with delay as well as the effects of prehospital and in-hospital delay on outcome. Methods: We conducted a 1-year prospective cross-sectional study, which included all cases of surgically treated acute abdomen and abdominal trauma admitted to St Paul General Specialized Hospital, Addis Ababa, Ethiopia and Gondar University Hospital, Gondar, Ethiopia. Standardized data collection forms were completed for all cases from 1 May 2008 to 30 April 2009. Data were analyzed using Epi Info version 6 and SPSS version 13. Results: A total of 504 patients were studied. Diagnoses were: intestinal obstruction (34.6 %), appendicitis (33 %), and perforated peptic ulcer (3.6 %). Sixty-six percent of patients over 45 years of age, 60% of females, and 61% of intestinal obstruction cases were operated on within 3 days of illness onset. The 35% of patients who were operated on more than 3 days after the development of symptoms had a mortality of 67%. Fifty-four percent of the cases with a total prehospital and in-hospital time of more than 3 days had initially visited other health institutions. Conclusions: Delay of surgical intervention of more than 3 days for acute abdomen or abdominal trauma adversely affected outcomes. Women, patients older than 45 years of age, patients with intestinal obstruction, and those who were referred from other health facilities were delayed and had adverse outcomes. Keywords: delay in surgery; acute abdomen; abdominal trauma; surgical systems improvement

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

East and Central African journal of surgery: The Canadian connection

The Editorial Board of the East and Central African Journal of Surgery (ECAJS) has been expanded and now includes 3 Canadian Surgeons, among them the co-editors of the Canadian journal of Surgery (CJS), Jonathan Meakins, Edward W Archibald Professor and Chair Department of Surgery, McGill University, Montreal and James Waddell the AJ Latner Professor and Chairman of Orthopaedic Surgery, University of Toronto. Their participation recognises the importance of the ECAJS, and is a vote of confidence in its potential

Traumametrics

In this thesis, measurement theory and the statistical evaluations of diagnostic test performance are applied to the measurement of injury severity. Relevant issues in traumatology, the rationale for measurement of injury severity and the importance of likelihood ratios (LRs) and Receiver operator characteristic (ROC) curve analyses are discussed. An assessment of the definition, scaling mechanism, reliability and validity of 22 severity instruments is organized into a reference guide. Data sources for this thesis include the literature, the Vancouver General Hospital trauma registry and the Pennsylvania State University trauma registry.The LR and the area under ROC curves (A$sb{ rm uc}$) are calculated from the best published evaluations of four triage instruments. The CRAMS, PHI, and RTI, which include anatomic information, are superior to the RTS, which contains only physiologic information.A paired ROC curve analysis of the RTS and the RTI demonstrates that the performance of the RTI is equivalent to the RTS when mortality is the outcome; however the performance gain of the RTI over the RTS is 35% when major trauma is the outcome evaluated.Explanations for differences in predictive validity are sought by evaluating scaling mechanisms, reliability and content validity. (Abstract shortened by UMI.

LETTER TO THE EDITOR: Injury Prevention Initiative for Africa: Achievements and Challenges

INTRODUCTION: We would be most grateful if you brought to the attention of the readers of African Health Sciences, the following information for IPIFA. The Injury Prevention Initiative for Africa (IPIFA) ratified its constitution at the fourth Annual General Meeting in February 2001. At that meeting, members from 8 African countries, and Associate members present, chose 9 representatives to constitute the IPIFA steering committee. The countries represented were Egypt, Ethiopia, Kenya, Mozambique, South Africa, Uganda, Zambia and Zimbabwe. The executive was re-elected: Erastus Njeru (Kenya), President; Olive Kobusingye (Uganda) Secretary General, and Fatma Hassan (Egypt) Treasurer. The Injury Control Center Uganda (ICC-U) was designated as the IPIFA secretariat and IPIFA was registered as an NGO in Uganda in 2002. African Health Sciences 2002; 2(1): 41-4