Massive Cervico-Lingual Cystic Hygroma

Cystic Hygroma (CH) is an aberrant proliferation of lymphatic vessels  creating fluid-filled sacs that result from blockage in the abnormal lymphatic system. These benign lesions are characteristic in their capability to grow to an enormously huge size has potential pressure effects on the neighboring structures. The massive expansion can also lead to gross disfigurement of the neck and face. In this paper, we present a rare case of cervico-lingual CH in a 17-year old Rwandese boy. Though the lesion had caused massive expansion of the tongue (12cm x 10cm) and led to gross deformity of the mandible, the boy had no signs of respiratory distress. His main concerns were inability to eat solid foods and compromised speech. The management challenges and literature review on cystic hygroma of the head and neck region are discussed.Key Words: Cystic Hygroma, Cervico-Lingua

Pattern And Clinical Characteristics Of Firearm Injuries

Objective: To determine the pattern and characteristics of patients admitted with firearm injuries (FAls) and establish the morbidity and mortality associated with these injuries. Design: Retrospective cross-sectional study. Setting: Kenyatta National Hospital (KNH), January 2004 to December 2005. Subjects: All patients admitted with physically evident firearm injury. Results: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (

Aetiology, pattern and management of oral and maxillofacial injuries at Mulago National Referral Hospital

Objective: To establish the aetiology, pattern and methods of  management of oral and Maxillofacial injuries (OMFIs) seen at the Oral and Jaw injuries unit of Mulago National Referral Hospital (MNRH) Kampala, Uganda, over a ten year period.Design: A descriptive retrospective study.Setting: Oral and jaw injury unit of Mulago National Referral Hospital, Kampala, Uganda.Results: One thousand two hundred and three patient records met the inclusion criteria. The age range was 1-90 years with a male: female ratio of 4.5:1. The age-group most affected was the 21-30-year-olds. Road traffic injuries (RTIs) were responsible for 61% (n=735 of the injuries, interpersonal violence27.6% (n=332), accidental falls 12% (n=142) and firearm injuries 2.2% (n=27). Of the maxillofacial fractures (n=1069)isolated mandibular fractures were 62%, isolated mid-facial fractures 24% whereas Pan-facial fractures accounted for 14% .Conclusion: The victims of OMFIs were mostly young men between 21 and 30 years of age. The main aetiological factors were road traffic injuries (RTIs) and interpersonal violence (IPV), while the lower third of the face was most often involved. Consistent with findings in other studies, RTI and IPV remain the two main causes of Maxillofacial injuries and public health measures targeting prevention should focus on these areas

Intra-myocardial Bullet causing heart block in a patient with multiple gunshot wounds: Case Report

Elective removal of intra-myocardial bullet remains a controversial subject. A non-operative approach has been recommended as appropriate for a stable asymptomatic patient. In the presence of complications such as bleeding, perforation leading to cardiac tamponade, thrombus formation, embolization, rhythm disturbances and infections, surgical removal may be advised. We present a patient who survived multiple gunshot wounds with a bullet lodged in the wall of the left ventricle of the heart. Details of the injuries sustained, operative removal of the bullet and the challenges that ensued are illustrated

Maxillofacial soft tissue injuries in Nairobi, Kenya

Objectives: To determine the aetiological factors and pattern of occurrence of maxillofacial soft tissue injuries (MF-STIs) presenting at a Kenyan National Referral Hospital in Nairobi.Design: A cross-sectional study.Settings: The accident and emergency department of the Kenyatta National Hospital (KNH) between September 2009 and December 2009.Subjects: Four hundred and twenty two patients treated for MF-STIs.Results: The male to female ratio was 3.3:1. Motor vehicle accidents (MVA) were the leading cause of MF-STIs (44.6%) followed by interpersonal violence (IPV) (39.1%). MVA (50.0%) was the leading cause of MF-STIs in the less than 12- year-olds while falls from heights (58.3%) was the leading cause in under five-year-olds. IPV (48.1%) was the leading cause of facial fractures. There were no skeletal fractures observed in the under five-year-olds. Head injury (36%) and fractures of the long bones (52%) were the most common associated injuries.Conclusion: The leading causes of MF-STIs apparently differ from those of skeletal fractures

Lip-Synch Gospel: Christian music and the ethnopoetics of identity in Kenya

In recent years there has been an outpouring of Kenyan scholarship on the ways popular musicians engage with politics in the public sphere. With respect to the rise in the 1990s and 2000s of gospel music – whose politics are more pietistic than activist – this article challenges how to ‘understand’ the politics of gospel music taken from a small speech community, in this case the Meru. In observing street performances of a new style of preaching, ‘lip-synch’ gospel, I offer ethnographic readings of song lyrics to show that Meru’s gospel singers can address moral debates not readily aired in mainline and Pentecostal-Charismatic churches. Critical of hypocrisy in the church and engaging with a wider politics of belonging and identity, Meru gospel singers weave localized ethnopoetics into their Christian music, with the effect that their politics effectively remain concealed within Meru and invisible to the national public sphere. While contesting the perceived corruption, sin and hypocrisy in everyday sociality, such Meru gospel singer groups cannot rightly be considered a local ‘counter-public’ because they still work their politics in the shadows of the churches

Ocular injuries in survivors of improvised explosive devices (IED) in commuter trains

<p>Abstract</p> <p>Background</p> <p>Ocular injuries are common in survivors of terror incidents that involve the use of explosive materials. These explosives are commonly of a High Explosive type (HE) and may be fashioned into improvised explosive devices (IED) that incorporate additional materials to maximise trauma and injuries. Serial IED explosions have occurred in commuter trains in several cities including London and Madrid but data on ocular injuries is limited. We report the ocular injuries of the survivors of a series of IED explosions in crowded commuter trains.</p> <p>Methods</p> <p>28 patients (56 eyes, 28 male, ages ranging from 22 to 52 years (mean 35.27 years) were screened in the triage area or the Intensive Care Unit (ICU). Testing included bedside visual acuity testing, torchlight examination of the anterior segment and dilated (or if necessary, undilated) fundus examination. Selected patients underwent B-scan examination, magnetic resonance imaging of the brain, orbits and the optic nerves or visual evoked potential assessment. The injuries, investigations and procedures were entered into the patient's case sheet as well as into a standardised format suggested by the Indian eye injury registry (IER).</p> <p>Results</p> <p>16 of 28 patients (57.1%) had ocular injuries whereas 12 (42.8%) were found to be normal. Injuries were seen unilaterally in 10 patients and bilaterally in six yielding a total of 22 injured eyes. The common injuries were periorbital haemorrhages (09 eyes, 40%); first or second degree burns to the upper or lower lids (seen in 07 eyes, 31.8 %) and corneal injuries (seen in 08 eyes, 36.3%). Open globe injuries were seen in two eyes of two patients (09%). One patient (4.5%) had a traumatic optic neuropathy.</p> <p>Conclusion</p> <p>Ophthalmologists and traumatologists should be aware of these patterns of ocular injuries. Protocols need to include the screening of large numbers of patients in a short time, diagnostic tests (B scan, visual evoked potential (VEP) etc) and early surgery preferably at the initial triage itself as most of the serious injuries in our studies had been missed or not treated at an initial assessment.</p

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work