Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the factors influencing the outcome of SV in Northern Uganda. Methodology: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted between January 2012 to December 2012 and surgically managed in 19 hospitals in Northern Uganda and followed up postoperatively for 30 days. Surgical management was by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University and Uganda National Council for Science and Technology. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality. Results: Eighteen(17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.30-18.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.Keywords: Sigmoid volvulus, factors, influence, outcom

Skin grafts : local quest for viable alternatives to autologous grafts using silk and acellular dermal matrices

The gold standard with regards to skin transplantation is the use of the patient’s own skin obtained from a healthy donor site. Such grafts can be either full thickness skin or more commonly nowadays, split thickness skin. Various materials, having either natural and or synthetic origins, have been used in the engineering of skin substitutes to-date and these grafts are then confronted against autologous skin grafts. If proven to be successful, such matrices could be utilised in clinical applications such as in the treatment of burn wounds and in cases of skin ulcers amongst others. In this study the primary cells used, keratinocytes and fibroblast, were obtained from donor skin and cultured. Scaffolds of xenogenic (raw silk) as well as of allogenic (acellular dermal matrices) origins were obtained via low-cost methods and seeded using the fibroblasts and keratinocytes so as to determine which gave the closest mimic to skin grafts. Out of the matrices assessed, the raw silk matrix allowed the best colonisation with skin cells in our hands. The ADM matrice also showed some cell colonisation, but will need further experimentation.peer-reviewe

Bronchography

This is a review of bronchography as practised in St. Luke's Hospital, Malta, over the years 1969 and 1970. A case study involving 40 patients who were investigated by bronchography, 26 cases had a definite bronchial or lung lesion, 14 cases had a normal bronchogram. The advantage of bronchography in the investigation of a lung or bronchial lesion it that demonstration of the lesion is clear cut with good definition. The amount of exposure to X-Rays is minimal and is equivalent to 3 exposures for a chest X-Ray which are of minimal duration. This is in contrast to tomography where the different cuts at different levels are taken with each exposure lasting between 1 and 3 seconds. The disadvantage, relative to tomography, is that the procedure is more uncomfortable for the patient. Neither bronchography nor tomography will supersede each other as a means of investigating a lung lesion. Bronchography and tomography are complementary.peer-reviewe

Molecular mechanisms in haematological malignancies

Haematopoiesis requires the constant production of large numbers of peripheral blood cells. This process is under tight control of transcription factor networks as well as cytokines, growth factors and hormones. We will review the importance of transcription factors in programming the haematopoietic lineage commitment and the role of the microenvironment and the corresponding cellular sensitivity to ensure production of mature functional cells in response to the physiological demand. Understanding the molecular mechanism of this complex process gives the opportunity to identify the underlying molecular deregulation in haematopoietic malignancies. The different levels of deregulation include hyperproliferation, block in differentiation and sensitivity to growth factors. In this review, leukaemic transformation is selected to give evidence of cell signalling deregulation. The clinical implications will be reviewed in the context of the potential opportunities in the future to identify specific therapeutic patient groups that can be defined using prognostic and predictive biomarkers.peer-reviewe

Vibrio parahaemolyticus food poisoning

Vibrio parahaemolyticus is an obligate halophile, with a high alkaline tolerance, typically found in estuaries at temperatures of 20 to 45°C and commonly infecting shell fish, crabs, squids, etc. It is responsible for outbreaks of summer diarrhea in South East Asia, Europe, and around Coasts of Cornwall, but particularly, in Japan, because of take-away meal shops, the short generation time of 10 minutes, the alkaline dishes and raw fish dishes served, and the asymptomatic carriers among food handlers. A case study of a young seaman who was diagnosed with vibrio parahaemolyticus food poisoning is presented and discussed, also emphasizing on the awareness of the microbiologist about its possibility as a cause of food poisoning.peer-reviewe

Novel applications of COX-2 inhibitors, metformin, and statins for the primary chemoprevention of breast cancer

Recent evidence shows that commonly prescribed drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), metformin, and statins, may have beneficial roles in the primary chemoprevention of breast cancer. Therefore, these drugs could potentially be used in addition to the hormonal drugs currently used for this purpose (namely, selective estrogen receptor modulators and aromatase inhibitors) due to their alternative mechanisms of action.peer-reviewe

Survey of hemoglobin, blood urea and plasma uric acid concentrations among a sample of the Maltese population

The primary purpose of this survey was to establish the averages of hemoglobin concentration, blood urea level and Plasma Uric Acid in a sample of the Maltese population. This survey was made on blood donors to the Blood Transfusion Centre at St. Luke's Hospital, Malta. Following the study of 292 male and 41 female blood donors aged 18 to 65 years, it was found that the average hemoglobin concentration is 14.5 mg./100 ml. for males and 12.7 mg./100 ml. for females; Uric Acid values average 4.9 mg./100 ml. among males and 4.3 mg./ 100 ml. among females; and the mean blood urea values for males and females are 31.8 mg./ 100 ml. and 30.9 mg./100 ml. respectively. No correlation was noticed between these values and the ABO Blood group system. Most of the blood donations came from people whose age ranged from 25 to 49 years.peer-reviewe

Some facts about leukemia in Malta

This analytical study of the records available of all reported cases of leukemia during the period January, 1966 to December, 1969 aims at pointing out the inter-relationship between type, age, sex, month and year incidence. The frequency of occurrence of the main types of leukemia and the relationship between the age and the type of leukemia are presented. An important feature shows that in this four-year period there was one of each of the following types: Stem cell leukemia, megakaryocytic leukemia and plasma cell leukemia. With regards to sex distribution, it is interesting to note that the ratio of incidence is approximately twice as high in males as in females. This report is limited to a short period and the number of cases is few. There is, however, an increasing incidence of leukemia in Malta as elsewhere. A more detailed study is indicated; this should possibly be inclusive of all reported cases of malignant disease of the blood-forming tissues.peer-reviewe