Forensic Anthropological Examination and DNA Analysis in the Identification of Human Remains in Rwanda

The identification of human remains plays a big role in solving legal and social challenges. To date; significant strides have been made to help positively identify human body remains following both natural and man-made disasters as well as reported cases of missing individuals. Thorough anthropological examination and DNA analysis of the remains can be used to conclusively link the profiles of the remains to persons if a potential living match is available even after a long period of time. We present cases of excavated human remains and samples from Rwanda that were part of both legal and social disputes. Following anthropological examination and DNA analysis; the disputes were conclusively settled. This case report also highlights the possibilities as well as challenges of identifying victim remains of larger calamities such as the 1994 Genocide perpetrated against the Tutsis in Rwanda in which an estimated one million Tutsis lost their lives

Rotavirus Gastroenteritis Surveillance and Prevalence Assessment among Under Five Children in Rwanda

Rotavirus remains the most common cause of severe childhood diarrhea worldwide and of diarrheal mortality in developing countries. Despite the efforts made by the government of Rwanda and the stakeholders to reduce children mortality; the prevalence of rotavirus among under five children in Rwanda remains to be determined. We conducted a hospital-based cross-sectional study that aimed at determining the prevalence of rotavirus infection in under fie children presenting with gastroenteritis in eight hospitals in Rwanda. From June 2013 and August 2014 we collected and tested stool samples for the presence ofrotavirus using an enzyme immunoassay and a Real Time-Polymerase Chain Reaction for genotyping. In 969 stool samples; 232 (23.94 and 5.1) while the lowest one was observed in March (0.00). Muhima Hospital had the highest prevalence (33.33) whereas Kabgayi and Rwamagana Hospitals had the lowest (15.62 and 18.18; respectively). Male children were more affected than females (25.8 versus 21.5). We found that the prevalence was higher (31.10) in children aged between 12 and 24 months than in other age groups. For genotyping; G9 [P8] was the most prevalent genotype as G9 prevalence was 54.6 whereas [P8] prevalence was 73.9.In conclusion; the prevalence of rotavirus gastroenteritis was high among children aged less than 5 years; and it was different according to age groups and among different hospitals

Immunological Profiles in HIV Positive Patients Following HAART Initiation in Kigali; Rwanda

Background: Interleukin-10; IL-2 and IFN -? are some of the crucial cytokines associated with HIV infection and pathogenesis. While IL-2 and IFN-? play critical roles in host resistance to infection; IL-10 inhibits the synthesis IFN-?; IL-2 at mRNA and protein level; exacerbating damage to immune system. Objective: To determine the levels of; changes in and correlation between CD4 count; viral load; IL-10; IL-2 and IFN-? before HAART and at six months of HAART among HIV positive patients in Kigali; with a view to understand cytokine networks particularly in relation to HAART ; and to see whether they can be used as alternative markers of the disease progression. Design: Longitudinal study. Setting: Kagugu; Kimironko; Biryogo; Gitega Health Centres and Centre Medico-Social Cornum; all located in Kigali. Subjects: Thirty three (33) HAART initiation eligible HIV positive patients including 13 women and 20 men. Results: A drop in viral load (though only a small number of patients achieved an undetectable viraemia); a recovery of CD4+ cells; a decrease in IL-10 (though it remained high for many patients especially those with unchanged viraemia); and an increase in IL-2 and IFN-? indicated a successful HAART . A negative correlation between CD4 count and viral load and between CD4 count and IL-10 (but r -0.5) was observed. IL-10 correlated positively and strongly with viremia (r 0.5 at both time points: p-values 0.05). There was no significant correlation between CD4 count; IL-2 and IFN-?. Conclusion: Results demonstrated the down-regulatory effect of IL-10 on Th1 cytokines and that a shift from Th1 to Th2 cytokine is associated with HIV disease progression. A successful HAART results in CD4+ cells recovery; drop in viraemia and IL-10 with up-regulation of Th1 cytokines. Also; findings show potential usefulness of IL-10 as a marker of HIV disease progression

Sputum concentration improves diagnosis of pulmonary tuberculosis cases in children at a tertiary care institution in Rwanda

Introduction: A great concern exists about the emergence of antibiotic resistant organisms. The goal of this study is to delineate antibiotic sensitivity patterns at King Faisal Hospital. Methods: A three years study; from Jan 2009 to Dec 2011 was conducted in the Microbiology unit; department of Laboratory; King Faisal hospital; Rwanda. All the specimens and antibiotic sensitivity were processed according to the standard guidelines. Microorganisms and their sensitivity data were reviewed and compiled by using hospital information system. Results: Over the 3-year period; several Enterobacteriaceae pathogens declined in susceptibility to various antimicrobial agents. A total of 2153 Enterobacteriaceae were isolated. Most common isolate was Escherichia coli check for this species in other resources (1413) followed by Klebsiella check for this species in other resources species (550); Enterobacter check for this species in other resources species (110); Proteus check for this species in other resources species (165); Citrobacter check for this species in other resources Species (79); Shigella check for this species in other resources species (110) and other species. Most notable were the decreased sensitivities to cefuroxime: E. coli (84 to 72); Klebsiella (78 to 33); Enterobacter (50 to 41) Proteus(67 to 59) and Shigella to ciprofloxacin (100 to 96). And also decreased sensitivities to Imipenem: E. coli (100 to 98) and Klebsiella species (100 to 94). Conclusion: These decreased antibiotic sensitivities reflect increased bacterial selection pressure as a result of widespread antibiotic use. A combined approach involving infection-control specialists; infectious disease physicians; and hospital administrators is necessary to address this increasingly difficult problem

Descriptive Cases Sudy of Care; Surveillance and Prevention of Birth Defects in Rwandan Children

"""According to the World Health Statistics 2008; about 260 000 neonatal deaths worldwide are caused by Congenital anomalies. This fiure represents about 7 of all neonatal deaths"". In our study; birth accounted Defects for 14.9 out of 581 recruited infants with birth defects (87 cases). In this series; 52.9 were Female whereas 47.1 were male.13.8 were premature babies (=37weeks); 74.7 aged 5 months and 11.5 were infants aged between 5 and 12 months. Polymalformative conditions were the most common Cause of death identifid in 21 cases (24); gastrointestinal birth defects caused death in 15 cases (17); nervous system in 14 (16); Cardio-vascular birth defects in 10 cases (12); Chromosomal abnormalities In 10 cases (12); musculoskeletal defects in 10 cases (12); congenital mass in 2 cases (2); oral defects in 2 cases (2); congenital skin defect in 1 case(1); whereas congenital respiratory defect and genitourinary malformations in 1 case each (1).Over 50 patients died in referral hospitals and 77 died after 24 hours of life"

Factors Determining Disclosure by Parents among Children Living with HIV/AIDS Attending the Center of Excellence in Kigali University Teaching Hospital

"The increasing access to antiretroviral therapy (ART) and survival of HIV-infected children has raised challenges on disclosing HIV diagnosis to children. Many parents and guardians are reluctant to allow children living with HIV to know their status; arguing that they are too young and will not understand fully their circumstances causing emotional disturbances as a result. There are further concerns that children may blame their parents and ask questions on how they got the disease; even inadvertently ""blurting out the secret"" and thus exposing the family to stigma and discrimination. In this cross-sectional study; eligible children were recruited to participate. Data on these children was obtained from the electronic databases and completed with data extraction from the individual patient fie. A sample of both parents and guardians who disclosed and those who did not disclose have been interviewed to identify the factors and reasons behind their decision-making process in addition to what they believe would improve their disclosure. A total of 64of HIV positive (HIV+) children had their status disclosed to them by parents while 35.8 did not. The majority of parents or guardians (80) found that disclosing status improved adherence. A large number of parents or guardians (67) attended psychosocial support groups and accordingly disclosure status was highly associated with psychosocial support group attendance (p0.05). Disclosure and statistical tests showed that disclosure status was highly associated with CD4 outcomes (p0.05). In addition; disclosure status was highly associated with viral load outcome (p0.05). Moreover; 64.4 of children living with HIV underwent an increase of weight greater or equal 4 kg after disclosure and statistically disclosure status was highly associated with weight outcomes (p0.05)."

Management Challenges of Pediatric Infective Endocarditis at Tertiary Level in Rwanda

Background: Management of Infective Endocarditis (IE) has been of great challenge for many years. Rapid diagnosis; effective treatment; and prompt recognition of complications are essential to good patient outcome as this condition is associated with a high morbidity and mortality in both adults and pediatric patients. In limited resources settings; management of IE is still a challenge due to early inappropriate antibiotherapy and therefore difficulties in its diagnosis and treatment. Objectives: To elicit challenges in management of patients suspected of IE at tertiary level in Rwanda. Methods: We report four patients with IE. For these patients; Duke's criteria were considered in making the diagnosis. Results and Conclusion: IE has protean clinical symptoms and signs; and can be of challenging diagnosis. The patients reported constituted a clinical challenge in the diagnosis and management of IE but most of them had had favorable outcome. The main clinical challenge was the prolonged stay to peripheral settings with inappropriate antibiotherapy which made most of the blood cultures falsely negative. Echocardiography and serial blood cultures provide the key to diagnosis as per Dukes criteria. Being alert to this mentioned challenge is crucial. As the key investigations are not steadily available in most peripheral health facilities; we strongly recommend early referral to tertiary level for all cases of suspected IE before initiation of antibiotherapy

Clinical and Genetic Diagnosis of Multiple Osteochondromas in Rwandan Patients

Multiple Osteochondromas (MO) or hereditary multiple exostoses (HME) is an autosomal dominant skeletal disorder mainly characterized by multiple osteochondromas predominantly located at the growth plates of long bones. MO is a genetically heterogeneous disorder and results from mutations in EXT1 and EXT2 genes located on chromosome 8q23-q24 and 11p11-p12. We hereby report a case of a 23-year-old girl who presented characteristic clinical and radiological features of MO. The same clinical signs were observed in her relatives. The p.Arg340Cys mutation in the EXT1 gene was found in the proband confirming the clinical diagnosis. A surgical management was carried out in all affected bones which consisted of excision of the bigger and pain full osteochondromas. The patient was informed of her problem and genetic counseling was offered to the family's members

An Unusual Case of Double Aneuploidy of Down Syndrome Associated with Triple x Syndrome: 48;xxx;21

Down syndrome is the most common chromosomal abnormality in humans with an estimated incidence of one case in 770 live births. However; the occurrence of double aneuploidy involving autosome and or sex chromosome is a very rare phenomenon in lives born and the majority of reported cases are presented in form of spontaneous abortions. Here; we are reporting a case of a Rwandan patient with combination of trisomy 21 and triple X syndrome. The proband was 8-month-old female with typical features of Down syndrome. In additional to Down syndrome features; the child presented with minor features of triple X syndrome characterized by hypotonia and seizures