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Diabetic Foot Ulcers: Surgical Characteristics, Treatment Modalities and Short-Term Treatment Outcomes at a Tertiary Hospital in South-Western Uganda
No full textAbstract
Background: Diabetic foot ulcers (DFUs) are a prevalent and serious consequence of poorly controlled diabetes. Hospitalizations are frequent among DFU patients, and these patients are at risk of lower extremity amputations (LEA). Uganda has few studies detailing DFUs and their management. We described the surgical characteristics, treatment modalities and short-term treatment outcomes of DFUs at Mbarara Regional Referral Hospital, in southwestern Uganda.
Methods: A prospective cohort study involving 62 patients with DFUs was conducted from February 2021 to September 2021. We
captured socio-demographic data, surgical characteristics, treatment and treatment outcomes of DFUs over a 5-week follow-up period, through an interviewer-administered structured questionnaire. Descriptive statistics were used at analysis.
Results: The mean age of participants was 57.0 ± 12.27 years, comprising 35 (56.5%) females. Majority had diabetes mellitus (DM)
for more than 10 years, predominantly type 2 (93.5%), and 33.9% with very poor glycaemic control (HBA1c>9.5%). Most ulcers
involved the toes (27.4%), with 80.7% being large (>3 cm2
). Severe DFUs (Wagner grade 3–5) were seen in 66.2% of patients.
Clinically infected ulcers mainly had Pseudomonas spp cultured. Arterial occlusion was detected in 35.5% through lower extremity
Doppler ultrasonography. Initial surgical interventions were surgical debridement and LEA performed in 50.0% and 46.8%, respec tively. Eight (42.1%) patients suffered surgical site infection, while 26.3% had persistent gangrene after initial surgery. Revision
surgery was performed in 25.8% of the participants. Mortality rate was 1.6%, and mean length of hospital stay was 17.0 ± 11.1 days.
Conclusion: More than half of the patients had advanced DFUs (Wagner grades 3–5). Poor glycemic control and late presentation
were common. Lower extremity amputation was a common initial treatment modality for DFUs. Routine lower extremity Doppler
ultrasonography is recommended to assess peripheral arterial disease for DFU patients. Wound swabbing for culture and sensitivity
testing is encouraged for appropriate antibiotic coverag
Prevalence of pulmonary tuberculosis and the associated clinical symptoms in Western Uganda
No full textAbstract
Pulmonary tuberculosis is a public health problem affecting over 5.8 million people worldwide per year. Burden of the disease varies across populations due to differences in biological and behavioral factors. In Western Uganda, the prevalence of pulmonary tuberculosis was not established and there was continued use of a biased clinical tuberculosis description guideline during treatment. Therefore, a cross-sectional study was conducted among people ≥12 years attending Buhinga hospital in Western Uganda from April to June 2019 to achieve the following specific objectives; (1)-Determine prevalence of pulmonary tuberculosis by age group and sex, 2-Assess the clinical symptoms associated with pulmonary tuberculosis amongst the participants. Participants were recruited by simple random sampling technique and standardized questionnaire were administered to obtain demographic and clinical data. 379 sputum specimens were collected and tested for M. tuberculosis using Gene X-pert and Classical Real Time PCR. Data was analyzed using SPSS software version 13. Prevalence of pulmonary tuberculosis by age group was highest in 20-29 years, high in 30-39 years and ≥50 years and least in 10-19 years old individuals. Females had a slightly higher prevalence of pulmonary tuberculosis than males. Youthful behavior of active participation in social activities and advanced age health associated factors contributed to the high prevalence of pulmonary tuberculosis amongst the participants. There was no significant relationship between pulmonary tuberculosis disease and demography; - age group and sex (P-value = 0.24). All pulmonary tuberculosis cases presented with persistent fevers, coughs for ≥ 2 weeks, night sweats and noticeable weight loss in the hierarchical order. The relationship between pulmonary tuberculosis disease and clinical symptoms; - persistent fevers, cough, noticeable weight loss and night sweats (P-values; <0.001, <0.001, 0.001 and <0.001 respectively) was significant. Age and clinical symptoms are important pulmonary tuberculosis control hotspots.N/
The phenotypes and alleles frequencies of ABO blood groups in Western Uganda
No full textAbstract
ABO blood group system is one of the clinically significant blood classification systems that vary across populations. Knowledge of distribution of the ABO blood system can help us to predict herd immunity and transmissibility of a disease in a population. In Uganda, little was known about this system and no research had been carried out to elaborate on the distribution of the A, B, AB and O blood types. Therefore, a cross-sectional study was conducted among people ≥12 years attending Buhinga hospital in Western Uganda from April to June 2019 to determine the phenotypes and alleles frequencies of the A, B, AB and O blood groups. Participants were recruited by simple random sampling technique and demographic data was obtained. 379 venous blood samples were collected and tested for ABO sero-types. Phenotypic data was analyzed using descriptive statistics, chi-square test of association and Hardy-Weinberg law of computation. Frequencies of ABO phenotypes were in the following order; O (39.8%)>, A (39.6%) >, B (12.4%)> AB (8.2%). There was no significant difference in the A, B, AB and O phenotype frequencies between males and females (p-value= 0.91). Based on Hardy-Weinberg Law, frequencies of the A, B, O alleles were; 0.63 for the O allele, 0.27 allele for the A allele and 0.14 for the B allele. Predominance of blood group O is more likely to influence population immunity.N/
Malignant mixed mullerian tumor: A case report about a uterine Tumor’s case
No full textIntroduction: Malignant mixed Mullerian tumor (MMMT) is an exceedingly rare and aggressive tumor which occurs predominantly in postmenopausal women though it has been reported rarely in premenopausal women.
Case presentation: A 54-year old nulliparous postmenopausal female presented with a 3-month history of vaginal bleeding, mild lower abdominal pain and weight loss. Ultrasound revealed markedly enlarged uterus with a hyper-echoic solid and cystic mass and a right adnexal complex mass. Total abdominal hysterectomy and bilateral salpingioopherectomy were done. Histopathological features were consistent with MMMT. The patient
is currently stable after 6 cycles of adjuvant chemotherapy which consisted of paclitaxel and carboplatin.
Clinical discussion: MMMT of the uterus is rare, high-grade neoplasms comprising only 1–2% of uterine cancers and 3–5% of all uterine malignancies. This tumor may arise in the ovaries, fallopian tubes and vagina. Histologically, MMMT is a biphasic tumor composed of both epithelial (carcinoma) elements and mesenchymal (sarcoma) elements; though, which component is responsible for the tumor’s aggressive biological behavior
remains undetermined.
Conclusion: MMMT is a rare and aggressive tumor which is commonly seen in postmenopausal women with high rate of recurrence therefore, Radical surgery and close follow-up is mandatory since the role of chemoradiotherapy remains unclear in the management of patients with this tumor. Both stage of the tumor and myometrial invasion are considered as potential prognostic factors
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No full textAbstract
Aim: This study was conducted to determine the correctness and completeness of
documentation of partographs.
Design: This was a retrospective descriptive study.
Methods: We included 365 partographs of deliveries conducted from January 1st to
October 31st 2019. Data were collected using a checklist and analysed descriptively.
The study based on 13 partograph parameters.
Results: About 8–13 parameters were correctly documented in 71.5 % of the
partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had
no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine
contractions and cervical dilatation respectively. About 12.1% of the cervicographs
crossed the action line and 61.4% of partographs where cervicographs crossed the
action line had no documentation of action(s) taken
SEXUALLY TRANSMITTED INFECTIONS SCREENING AND MANAGEMENT AMONG ADOLESCENTS AND YOUNG ADULTS ATTENDING OUTPATIENTS CLINICS
No full textThe ongoing project under RIFSexually transmitted infections (STIs) are infections that can be passed on during unprotected sex and intimate skin-to-skin contact.
Many STIs don’t have any symptoms. This means an adolescent can have an STI without knowing it and pass it on to the partner during sex or close contact.
These include gonorrhea, syphilis, HPV, herpes, genital warts, HIV, hepatitis B, and chlamydia. Most are easily treated, especially when they are discovered early.
If left untreated, STIs can lead to serious health problems [3].-Infertility, death, Pelvic Inflammatory disease, emotional and mental illness, transmission to infants.Government of Ugand
Effect of COVID-19 on Teso Sub-Region Community in Eastern Uganda
No full textIn a very special way, the researchers wish to
recognise the contribution of Mr. Joseph Elungat,
Assistant Lecturer in the Department of Information
Technology at Kumi University. He gets the special
thanks for assisting the researchers in the critical
process of analysing the study’s data.The study aimed to achieve two main objectives. First, it sought to assess the effect of COVID-19 on the social
wellbeing of people of Teso sub-region. Secondly, it sought to assess the effect of COVID-19 on the economic
wellbeing of people in Teso sub-region. The study further sought to make recommendations on some of the practical
ways that can enable the people of Teso to deal with COVID-19 and to survive in an era now globally known as the
“new normal.” The research design was a descriptive cross-sectional study among community members in three
representative districts of Teso, namely Soroti, Katakwi and Kumi. Information from members of the community was
collected using a closed-ended questionnaire comprising statements regarding the social and economic wellbeing of
the people of Teso. The information was later descriptively presented as frequency and percentage. Additionally, an
interview guide was used to collect data from members of District, Sub-county or Division Task Forces on COVID-19
in the three districts. The target population for this study was members of the Teso sub-region community. The sample
size for this study was 150 respondents drawn from local communities for quantitative data and 26 members of task
forces on COVID-19. A simplified quantitative analysis was used to capture three elements from quantitative data:
mean range, response mode and interpretation. The study found that there was a very high awareness about COVID-19
and its symptoms in Teso. It also revealed a depressing trend arising from the impact of COVID-19 on the economy of
Teso. Businesspeople were most affected adversely in economic terms.Non
Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up
No full textOriginal ArticleBackground: Gluteal fibrosis (GF) is a fibrotic infiltration of the
gluteal muscles resulting in functionally limiting contracture of
the hips and is associated with injections of medications into the
gluteal muscles. It has been reported in numerous countries
throughout the world. This study assesses the 5-year postoperative
range of motion (ROM) and functional outcomes for
Ugandan children who underwent surgical release of GF.
Methods: A retrospective cohort study of children who underwent
release of GF in 2013 at Kumi Hospital in Eastern Uganda.
Functional outcomes, hip ROM, and scar satisfaction data were
collected for all patients residing within 40 km of the hospital.
Results: One hundred eighteen children ages 4 to 16 at the time of
surgery were treated with surgical release of GF in 2013 at Kumi
Hospital. Of those 118, 89 were included in this study (79.5%).
The remaining 29 were lost to follow-up or lived outside the
study’s radius. Detailed preoperative ROM and functional data
were available for 53 of the 89 patients. In comparison with
preoperative assessment, all patients postoperatively reported
ability to run normally (P<0.001), sit upright in a chair
(P< 0.001), sit while eating (P<0.001), and attend the entire day
of school (P< 0.001). Passive hip flexion (P<0.001) improved
when compared with preoperative measurements. In all, 85.2%
(n= 75) of patients reported satisfaction with scar appearance as
“ok,” “good,” or “excellent” 29.2% (n= 26) of patients reported
back or hip complaints.
Conclusions: Overall, the 5-year postoperative outcomes suggest
that surgical release of GF improves ROM and functional
quality of life with sustained effect.
Level of Evidence: Level IV—case series.
Key Words: gluteal fibrosis, injection injury, pediatric hip contracture,
fibrosis surgery, treatment outcome, Ugand
The Silent Anaemia Epidemic in Children
No full textAbstract:-
Anaemia (haemoglobin level < 11 g/dl) is a silent epidemic that affects about 293.1 million children aged <5 years worldwide with 28.5% of those located in sub-Sahara Africa. Child hood Anaemia is associated with poor cognition, reduced growth, problems with immune function and ultimately decreased survival. Uganda’s childhood Anaemia is insidious, multifactorial and undefined. The objectives of the study were to determine the prevalence, severity and leading cause of Anaemia amongst children ≤ 12 years attending Virika hospital. The cross-sectional study employed both qualitative and semi-quantitative methods. Participants were sampled by convenience and simple random techniques. Parents were given short interviews to obtain participants demographic and necessary information. Blood, stool and anthropometric measurements were obtained from the participants and tested for complete blood count, malaria, HIV, sickle cell disease, helminthes and malnutrition respectively. Data was analyzed using Excel computer program.
Results show that Prevalence of Anaemia in children is high, presenting mostly in moderate form. Malnutrition plays a major role in the development of Anaemia. Nutritional support and awareness are key aspects in prevention of Anaemia development and progression. Other control interventions may include provision of improved diagnostic tests, optimizing compliance, appropriating referral practices, implementation of standard treatment guidelines and research.Non
A Cross Sectional Descriptive Study of HIV Positive Breastfeeding Mothers and their Infants in 10 Selected High-Volume Health Facilities in a Rural District in Western Uganda
No full textAbstract-
Introduction: Although Option-B plus has registered tremendous success in the Prevention of
Mother to Child Transmission (PMTCT) of HIV, the failure to follow the HIV testing algorithm for HIV
Exposed Infants (HEIs) after birth is likely to make achieving zero new HIV infections among children
unrealistic. Due to this, we sought to determine the factors affecting uptake of first Polymerase Chain
Reaction (PCR) test among HEIs to inform the selection of strategies to strengthen Early Infant Diagnosis
(EID), an indicator that tracks progress towards achieving zero new HIV infections in childre