Breast transillumination a viable option for breast cancer screening in limited resource settings?

Background: Mammography is an established screening tool for breastcancer in high-income countries but may not be feasible for most resourcepoor nations. Alternative modalities are needed to mitigate the impact of the increasing incidence and mortality due to breast cancer. This may require the development of new technologies or reevaluation of old technologies applicable to resource limited settings.Objective: To determine the sensitivity and specificity of breast transillumination as compared to mammography and to describe featuresof benign and malignant breast lesions as seen with breast transillumination.Methods: A single group descriptive analytical study was conductedover a six month period (2011) in the breast unit of Mulago Nationalhospital. Eligible participants were consecutively sampled. Participantsunderwent Clinical Breast Examination (CBE), breast transillumination(BT), mammography (MG) and histopathological analysis of identifiedbreast lumps. Sensitivity, specificity and predictive values werecalculated. Features of the masses detected by transillumination werethen described.Results: The number of participants recruited was 201 (mean age 42years, range 30-80 years). The average palpable lump size was 3.8cm (range 0.5 to 10 cm). BT had a sensitivity of 63.2% (PPV 86.8%) anda specificity of 89.5% (NPV 61.2%) with mammography as the referencestandard. Also, 73.3% of breast lumps with irregular margins and 88.5%with dense opacity at transillumination turn out to be malignant athistopathology examination.Conclusion: The Breast transillumination technique had a moderatesensitivity of 63.2%. This warrants a large scale population-basedevaluation of BT as a screening tool. This technique may not substitutemammography but to be considered an option where mammographyaccess is limited

Experience with ultrasound of the knee joint at Mulago Hospital, Uganda

Background: The knee is prone to various pathology. Mulago Hospital records of 2001/2002 show that an average of 432 patients with knee joint disorders are seen in orthopaedic and rheumatology outpatient clinics out of a total of 5400 patients annually. For a long time the only mode of radiological investigation for these patients has been x-rays of the knee joints and this meant that limited information was got about the soft tissue component of the knee. Advances in technology with high frequency transducers, power Doppler ultrasound and extended field of view function have facilitated the progressive development of musculoskeletal sonography (MS). In developing countries like Uganda, where advanced imaging modalities like MRI are unaffordable and not readily available, ultrasound U/S serves as an efficient substitute in trained hands. This study was aimed at describing the sonographic pattern of knee joint pathology at Mulago Hospital in patients with knee joint symptoms.Methods: A cross sectional descriptive study of the sonographic pattern of knee joint pathology was performed at Mulago Hospital from July 2004 –February 2005. A total of 107 consecutive patients referred to the Radiology department with knee joint pathology were studied. The patients’ socio-demographic data, clinical history and physical examination were recorded. Sonography of the knees was done using U/S machines [ATL-HDI 1500, Sonoace [Medison] SA8800 & SA9900] with high frequency linear transducers (7-12 MHz) The sonographic appearance of joint fluid, synovitis , loose bodies, bursae and cysts, tendon, mensci and ligament pathology were recorded. The data was entered in the computer using Epi-data soft ware and analysed using the SPSS version 10.Results: A total of 107 patients had their knee joints evaluated with U/S. The age range was from 2 months to 80 years. The mean age was 38.0 and median 36 years. The commonest presenting symptoms were painful swelling of the knee 55(51.4%), pain 39 (36.4%), swelling and inability to move were 6 (5.6%). Sonographic features revealed osteoarthrosis was the most frequent 22(59.5%), loose bodies were 7 (18.9%) and fractures 2(5.4%).Conclusion: U/S can ably evaluate the pathology of menisci, ligaments, tendons and muscles. The majority of the knee joint pathology disorders were as a result of the degenerative disease. In view of the fact that MRI is not readily available and is expensive, U/S goes a long way in contributing to the diagnoses of knee joint pathology in a low resourced countries like Uganda

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum.Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively.Results: Radiologists’ and students’ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated.Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda

BACKGROUND: Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context. METHODS: This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes. RESULTS: Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care. CONCLUSION: In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities

Diagnostic ultrasound patterns of parotid glands in human immunodeficiency virus-positive patients in Mulago, Uganda

OBJECTIVES: The purpose of this study was to determine sonographically, in parotid glands of human immunodeficiency virus-positive patients, the condition of glands with or without enlargement, and propose a classification system for the patterns observed using diagnostic ultrasound imaging. METHODS: In this prospective clinical study, ultrasound scans were performed on 200 patients aged 4–62 years at Mulago Hospital, Uganda. RESULTS: There were four main distinct ultrasound pathological patterns in the parotids, i.e. lymphocytic aggregations (LAs), lymphoepithelial cysts (LECs), fatty infiltration (FI) and lymphadenopathy only. There were additional subdivisions depending on the presence of echogenic foci and intraparotid lymphadenopathy. Of those patients (n = 64) without parotid enlargement, only 8% showed normal ultrasound features, whereas 34% showed LECs and 31% showed LAs. Of those (n = 136) with parotid enlargement, 46% showed LECs, 23% showed FI and 15% showed LAs. The overall prevalence of LECs in the study sample was 42%. LECs were multiple, mainly between 7 mm and 12 mm in diameter and 26% showed internal echogenic foci either mobile or stationary. In contrast, LAs tended to be ill-defined, less than 5 mm and were not associated with posterior acoustic enhancement. Features differentiating LAs from LECs have not been previously described. Parotid FI (lipodystrophy) was noted in patients on highly active antiretroviral therapy, who showed lesser prevalence of LECs after 12 months of treatment. CONCLUSIONS: Our study of 200 patients is probably the largest such study in the English language literature. The wide spectrum of diagnostic ultrasound patterns was categorized into four main groups (ten subgroups)

Experience with Ultrasound of the Knee Joint at Mulago Hospital, Uganda

Background : The knee is prone to various pathology. Mulago Hospital records of 2001/2002 show that an average of 432 patients with knee joint disorders are seen in orthopaedic and rheumatology outpatient clinics out of a total of 5400 patients annually. For a long time the only mode of radiological investigation for these patients has been x-rays of the knee joints and this meant that limited information was got about the soft tissue component of the knee.Advances in technology with high frequency transducers, power Doppler ultrasound and extended field of view function have facilitated the progressive development of musculoskeletal sonography (MS). In developing countries like Uganda, where advanced imaging modalities like MRI are unaffordable and not readily available, ultrasound U/S serves as an efficient substitute in trained hands. This study was aimed at describing the sonographic pattern of knee joint pathology at Mulago Hospital in patients with knee joint symptoms. Methods :A cross sectional descriptive study of the sonographic pattern of knee joint pathology wasperformed at Mulago Hospital from July 2004 –February 2005. A total of 107 consecutive patients referred to the Radiology department with knee joint pathology were studied. The patients’ socio-demographic data, clinical history and physical examination were recorded. Sonography of the knees was done using U/S machines [ATL-HDI 1500, Sonoace [Medison] SA8800 & SA9900] with high frequency linear transducers (7-12 MHz) The sonographic appearance of joint fluid, synovitis , loose bodies, bursae and cysts, tendon, mensci and ligament pathology were recorded. The data was entered in the computer using Epi-data soft ware and analysed using the SPSS version 10. Results : A total of 107 patients had their knee joints evaluated with U/S. The age range was from 2 months to 80 years. The mean age was 38.0 and median 36 years. The commonest presenting symptoms were painful swelling of the knee 55(51.4%), pain 39 (36.4%), swelling and inability to move were 6 (5.6%). Sonographic features revealed osteoarthrosis was the most frequent 22(59.5%), loose bodies were 7 (18.9%) and fractures 2(5.4%). Conclusion : U/S can ably evaluate the pathology of menisci, ligaments, tendons and muscles. The majority of the knee joint pathology disorders were as a result of the degenerative disease. In view of the fact that MRI is not readily available and is expensive, U/S goes a long way in contributing to the diagnoses of knee joint pathology in a low resourced countries like Uganda

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum. Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively. Results: Radiologists′ and students′ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated. Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM

Application of Case Report-Writing in the Training of Radiology Post Graduate Students at Makerere University.

Background: Postgraduate medical education is much sought after and has become an issue of global significance, appeal and dimensions. The Radiology postgraduate training at Makerere University has been in existence since 1980. As part of their training students are required to write up 30 cases with the help of their lecturers. Methods: We set out to evaluate the role of case report writing in the training of Radiology postgraduate students. A document analysis of 22 case report sets was done. Questionnaires with closed and open ended questions were administered to the 10 Radiologists and 6 students to get their opinions and ideas on the process and how it could be improved. The quantitative data was analyzed by a statistician and focused on the closed-ended statements. The qualitative data was analyzed by the authors with the help of a qualitative expert. Results: The radiologists and students agreed that case report writing helped students acquire a wide range of competences. They also agreed that it is a reliable and valid method of assessment and has a positive impact on learning. The respondents identified problems that were encountered in the process. They have problems identifying cases that are fully worked up and also their work was made challenging because of poor technology, limited access to references and high cost of producing the cases. The cases exposed the students to a wide range of cases and investigations in radiology and helped them integrate Clinical Medicine and Radiology. Conclusion: Case report writing is a good way of training and assessing post graduate students. It is motivational and also helps them acquire a wide range of competences specifically ability to write scientific articles