Evaluation of Intussusception after Monovalent Rotavirus Vaccination in Africa.

Postlicensure evaluations have identified an association between rotavirus vaccination and intussusception in several high- and middle-income countries. We assessed the association between monovalent human rotavirus vaccine and intussusception in lower-income sub-Saharan African countries.Using active surveillance, we enrolled patients from seven countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe) who had intussusception that met international (Brighton Collaboration level 1) criteria. Rotavirus vaccination status was confirmed by review of the vaccine card or clinic records. The risk of intussusception within 1 to 7 days and 8 to 21 days after vaccination among infants 28 to 245 days of age was assessed by means of the self-controlled case-series method.Data on 717 infants who had intussusception and confirmed vaccination status were analyzed. One case occurred in the 1 to 7 days after dose 1, and 6 cases occurred in the 8 to 21 days after dose 1. Five cases and 16 cases occurred in the 1 to 7 days and 8 to 21 days, respectively, after dose 2. The risk of intussusception in the 1 to 7 days after dose 1 was not higher than the background risk of intussusception (relative incidence [i.e., the incidence during the risk window vs. all other times], 0.25; 95% confidence interval [CI], <0.001 to 1.16); findings were similar for the 1 to 7 days after dose 2 (relative incidence, 0.76; 95% CI, 0.16 to 1.87). In addition, the risk of intussusception in the 8 to 21 days or 1 to 21 days after either dose was not found to be higher than the background risk.The risk of intussusception after administration of monovalent human rotavirus vaccine was not higher than the background risk of intussusception in seven lower-income sub-Saharan African countries. (Funded by the GAVI Alliance through the CDC Foundation.)

Additional file 1: of Development of a neonatal curriculum for medical students in Zimbabwe – a cross sectional survey

Data collection tool. These are the four questions on the data collection tool that were used in this survey. The focus group discussion was also based on the same question in the data collection tool. (DOCX 15 kb

Monozygotic twins with jejuno-ileal atresia

Introduction: Intestinal atresia is a congenital anomaly of the alimentary canal characterised by discontinuity of the bowel lumen that leads to intestinal obstruction in neonates. To our knowledge there have only been seventeen cases of twin pair with intestinal atresia thus far. We report this case and summarise all twins described in the literature to date. This may allow for a twin study in the future to help elucidate the aetiology of intestinal atresia. Presentation of case: We report on a pair of twins both of whom were referred with bilious vomiting, epigastric fullness and granular stools. Both x-rays showed proximal enteric dilatation with paucity of distal bowel gas suggesting jejunal atresia. The preoperative clinical state precluded surgery and both children deteriorated despite maximum intensive care, eventually succumbing to sepsis. Post-mortem was performed revealing jejunal atresia in both twins. Zygosity tests revealed the twins were monozygotic. Discussion: Intestinal atresia is one of the most common cause of neonatal intestinal obstruction. Management of these neonates in the developing world is plagued with late presentation and referral contributing to adverse outcome. Expeditious diagnosis and appropriate referral are paramount to avert dehydration, sepsis and malnutrition. Conclusion: Intestinal atresia in both twins is a rare clinical entity. Twin-pairs present unique opportunities to investigate the aetiology of diseases. Keywords: Intestinal atresia, Twins, Neonatal surgery, Jejunoileal atresi

Foreign body of the spleen from percutaneous entry

Foreign body (FB) aspiration and ingestion are fairly common in children. Sharp foreign bodies may also enter the body by penetration. In penetrating foreign bodies, commonly skin and the gastrointestinal tract are the affected organs. An impacted foreign body in the spleen is rare. The diagnosis can be challenging without a history of penetration. Herein, we report a case of an infant with a sewing needle that accidentally punctured the spleen after penetrating through the skin of the subscapular area. A history of FB penetration and imaging were essential to confirm the diagnosis. The sewing needle was successfully removed laparoscopically. Keywords: Child, Foreign body, Needle, Spleen, Laparoscop

Development of a Novel Global Surgery Course for Medical Schools

Objective: We endeavored to create a comprehensive course in global surgery involving multinational exchange. Design: The course involved 2 weeks of didactics, 2 weeks of clinical rotations in a low-resource setting and 1 week for a capstone project. We evaluated our success through knowledge tests, surveys of the students, and surveys of our Zimbabwean hosts. Setting: The didactic portions were held in Sweden, and the clinical portion was primarily in Harare with hospitals affiliated with the University of Zimbabwe. Participants: Final year medical students from Lund University in Sweden, Harvard Medical School in the USA and the University of Zimbabwe all participated in didactics in Sweden. The Swedish and American students then traveled to Zimbabwe for clinical work. The Zimbabwean students remained in Sweden for a clinical experience. Results: The course has been taught for 3 consecutive years and is an established part of the curriculum at Lund University, with regular participation from Harvard Medical School and the University of Zimbabwe. Participants report significant improvements in their physical exam skills and their appreciation of the needs of underserved populations, as well as confidence with global surgical concepts. Our Zimbabwean hosts thought the visitors integrated well into the clinical teams, added value to their own students’ experience and believe that the exchange should continue despite the burden associated with hosting visiting students. Conclusions: Here we detail the development of a course in global surgery for medical students that integrates didactic as well as clinical experiences in a low-resource setting. The course includes a true multilateral exchange with students from Sweden, the United States and Zimbabwe participating regularly. We hope that this course might serve as a model for other medical schools looking to establish courses in this burgeoning field