Blunt liver trauma in Mulago Hospital

Background: The paper presents 51 patients with blunt liver injury in Mulago national referral and teaching Hospital for Makerere University between Jan.1998-Jan.2003. Objectives: This study was aimed at finding the epidemiology, treatment and outcome of blunt liver injuries in Mulago Hospital.Methods: This was a retrospective study done using Hospital records of patients with liver trauma treated at Mulago Hospital from January 1998 to January 2003.Results: There were a total of 51 patients with liver injury. The male to female ratio was 17:1. The average age was 37 years, 39 patients had positive "peritoneal movement test", 30 patients had positive 4-quadrant tap, and 30 patients had at least 3 more injuries. None of the patients had Ultra Sound or Computerized Tomography (CT). All 51 patients had a laparotomy. At laparotomy, in 28 patients nothing was done to the liver, in 10 patients the liver as sutured, in 8 patients the liver was packed and in 4 non-anatomical resection of the liver was done. No liver transplantation was done. The commonest complications were fever (40 patients) jaundice (30 patients). 10 patients died (20%).Conclusion: Ultra sound or CT scan wound allow the haemodynamically stable patients to be treated non-operatively. The mortality rate of 20% is higher than in other series reported

A virtual reality input device for sports-related rehabilitation

Abstract. This work entails the hardware design, manufacturing and implementation of a VR controller device tailored for people with specific sports-related injuries. The target case of this thesis is the tennis elbow injury, where the designed controller helps them interface easily to the VR environment that is designed for their therapy. The sensors used are carefully selected in order to adequately capture the therapy exercise movements related to this kind of injury. For example, the use FSRs (Force Sensitive Resistors) that are put on the surface of a test object helps to detect a grasp during the exercise. The hardware design and manufacturing was done for a VR controller device that would give the desired performance, using Arduino IDE for its software development. In addition to this, the design of the VR environment allowed for an immersive VR experience for the rehabilitation. An experiment was carried out with eight participants, where they were asked to perform two exercises that involve grasping the test object. A series of questions were asked to them as part of the experimental evaluation. The results showed positive indications about the participants’ experience

Acute Cholecystitis – Current Views

Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and mainly affects those between 40 and 50 years1 and is closely associated with cholelithiasis. It occurs all over the world but Africa is a low risk area as compared to Europe and North America. The disease has been observed in children with ascariasis or those with acquired immune deficiency syndrome (AIDS). The commonest bacteria isolated in acute cholecystitis are E Coli. Clinical presentation includes a raised temperature. Leukocytosis may be absent even in those patients with gangrenous acute cholecystitis. However, Murphy's sign remains very specific. The mainstay of treatment remains surgical either open or laparoscopic cholecystectomy and in high-risk patients percutaneous or open cholecystostomy. Laparoscopic cholecystectomy has greatly increased operating time but reduced hospital stay. The over all mortality has remained 5-12% in the last 2 decades

Oestrogen receptor status and histopathological grade of primary breast carcinoma as determined by immunohistochemical assay

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Thyroid Dysfunction among Young Adults in Uganda

Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population.Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee.Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH (1.67) with a high fT4 (22.31) and one with a low TSH (0.03). The mean age of participants was 23 years, there were slightly more males 1.3:1.Conclusion: The prevalence of thyroid dysfunction in this cohort was low but falls in the range found elsewhere. These findings could inform the criteria of screening asymptomatic otherwise young health adults

Metastatic Breast Cancer and Hormonal Receptor Status among a Group of Women in Sub Saharan Africa

Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breast cancer patients in Uganda present with advanced disease. Many studies show that metastatic lesions frequently lodge in bones, lung and liver. Tumour hormone receptor status correlates with site of metastatic lesions and survival among breast cancer patients.Objective: To determine the sites of metastatic breast lesions and how they relate to the hormonal receptor status.Methods: In this cross sectional descriptive study, 71 women with histologically confirmed incident breast cancer with metastases were analysed, their hormonal receptor status was determined. All patients underwent a chest X-ray, an abdominopelvic ultrasound scan and a bone scan. The χ² and t tests were used to compare variables for statistical differences.Results: The mean age of participants was 45 years. Most metastases were to bone 56% (40/71), of these 45% (32/71 ) tumours were exclusive to bone and 94% of these (30/32) were ER+ . Of the 13 (18% of all patients) who had metastases to the liver, 7 were exclusive to the liver, and 1 (14.%) was ER positive. Of the 30 (42 %) patients with lung metastases, 23 patients were exclusive to lungs and 9/30 (39%) were ER+. In all 68% (48/71) were ER+, and bone metastases were associated with ER positivity and low grade tumors.Conclusion: Breast metastases had a preponderance to bone in this largely premenopausal group of women and these tumors were mostly ER positive. In the absence of tests to determine ER status, empirical antihormonal therapy may be used.Key words: Metastatic Breast Cancer, Hormonal Receptor Statu

Boda-boda injuries a health problem and a burden of disease in Uganda: A tertiary hospital survey

Background: Injury and deaths due to road traffic crashes are a major public health problem in developing countries. Boda bodas (motorcycles) are a practical and a sought after economic activity in Uganda’s capital and cities. The injuries related to boda bodas contribute significantly to the number road traffic injuries seen at Mulago hospitals, taking out significant resources including consumables and the health worker time. This study investigated the pattern of injuries, mortality and estimate cost of care.Methods: A prospective descriptive observational study over a 9 months period was carried out at Mulago Hospital and Complex, Accident and Emergency wards. The Study population was patients involved in Boda Boda related road traffic crushes. Consecutive patients presenting on every 3rd day were selected. Research Ethics committee approval was sought before the study was commenced.Results: A total of 124 patients presented with injuries that warranted at least an overnight stay at the Accident and Emergency ward. Out of the just over 2000 admissions, the majority were males (sex ratio F: M 1:3.5) There was one fatality. Injuries were in 7 categories namely Head, chest, abdominal, pelvic, spinal and soft tissues and extremity fractures. Helmet use in this study was 22%, an improvement from previous nearly zero percent. The estimated cost of care per injured patient was USD 300.Conclusion: Boda Bodas continue to be a major cause or agent of road traffic injuries and a significant economic burden. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws

Smoothed finite element method implemented in a resultant eight-node solid-shell element for geometrical linear analysis

International audienceA smoothed finite element method formulation for the resultant eight-node solid-shell element is presented in this paper for geometrical linear analysis. The smoothing process is successfully performed on the element mid-surface to deal with the membrane and bending effects of the stiffness matrix. The strain smoothing process allows replacing the Cartesian derivatives of shape functions by the product of shape functions with normal vectors to the element mid-surface boundaries. The present formulation remains competitive when compared to the classical finite element formulations since no inverse of the Jacobian matrix is calculated. The three dimensional resultant shell theory allows the element kinematics to be defined only with the displacement degrees of freedom. The assumed natural strain method is used not only to eliminate the transverse shear locking problem encountered in thin-walled structures, but also to reduce trapezoidal effects. The efficiency of the present element is presented and compared with that of standard solid-shell elements through various benchmark problems including some with highly distorted meshes

Gastric cancer diagnosis and treatment guidelines 2008: Uganda Cancer Working Group

In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention. However a better understanding of how it arises (risk factors) will be important in informing prevention and treatment strategies. The Uganda cancer-working group intends that this information is disseminated to wider readership in the region as part of the strategy of improving Oncological care service in the region

Oesophageal cancer management guidelines for Uganda

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