Critical appraisals and cultural acceptance of the dead donor rule: A revisit of the contemporary transplantation era

Transplantation remains one of the most rapidly expanding surgical specialties. Harvesting organs plays a crucial step in this highly complex surgical and communication process, and the moment at which vital organs can be donated depends on the declaration of end-of-life. This declaration must be performed by medical practitioners on the basis of clear standardized criteria of death confirmation, within competent local and regional jurisdictions, and with the use of confirmatory tests as indicated to ascertain the irreversibility of end-of-life. The current medically and legally accepted definition of death in most societies challenges the traditional and societal understandings of the process of end-of-life. Significant criticisms and cultural oppositions to transplantation still exist, and there is an ongoing debate about the role and the status of transplantation as surgical and medical sciences continue to evolve. By discussing the social acceptance and common understanding of end-of-life determination, we aim to highlight the current knowledge on transplant ethics with respect to the balance between the need to protect the potential organ donor and the need to donate organs at their utmost viability. No report has been done on social acceptance of transplantation in Rwanda or other Low- and Middle-Income countries (LMIC); though, as emphasis on organ transplantation evolves, we also aim to highlight the need for clear directions towards new transplantation regulations. Technical and non-technical critical arguments and moral acceptance are juxtaposed with the elucidated ethical and deontological principles to support the contemporary concept of the dead donor rule

Epidemiology of pediatric surgery in Rwanda: A one year review

Introduction: In Rwanda, as in other Sub-Saharan Africa countries, there is insufficient data on pediatric surgical conditions. Despite the lack of Pediatric Surgeons and Pediatric Anesthesiologists, Kigali and Butare University Teaching Hospitals receive and manage children with surgical conditions. Some of these patients could benefit from the expertise of specialists trained in Pediatric surgical conditions. Purpose: The aim of this study is to describe the pattern of pediatric surgery in Rwanda and to determine the prevalence of pediatric surgical conditions that require the expertise of a Pediatric Surgeon. Methods: This is a retrospective study carried out between August, 2013 and July, 2014. Data were obtained from theater books and operative database. Data analysis was done by SPSS 16 and MS Excel. Results: From August, 2013 to July, 2014, a total number of 1274 children were operated at Butare and Kigali University Teaching Hospitals. 391 (30.7) were female and 883 (69.3) were male, with a male to female ratio of 2.2:1. The age ranged between 1 day and 16 years, Mean age was 6.4 ± 4.9 years. Children under fie were 45.1%. 857 (67%) children needed the Pediatric Surgery specialty expertise. 369 (29%) patients were operated at Butare University Teaching Hospital, while 905 (71%) were operated from Kigali University Teaching Hospital. Trauma and burn: 466 (36.58%), congenital anomaly: 298 (23.39%) and Surgical infections: 188 (14.76%) were the three common diagnoses in pediatric surgery.Conclusion: Training of Pediatric Surgery sub-specialists, Anesthesiologists and Nurses will provide improved care in Rwanda. Education in trauma prevention, early screening and management of congenital anomalies, will improve service delivery to children with surgical conditions in Rwanda

Normal Conjunctival Flora as Seen in Adult Patients at Kigali University Teaching Hospital

The aim of this study was to assess the pattern of normal ocular bacterial flora isolated from patients attending the Department of ophthalmology at the Kigali University Teaching Hospital and to evaluate their in vitro susceptibility to common antimicrobial agents. From June to October 2011; collection of specimen was performed by rotating a sterile cotton swab on the lower conjunctival sac from the temporal to the medial fornix. Gram stain and culture was performed and antibiotic sensitivity determined in case of bacterial growth. Of the 120 collected samples; 74 (61.6) showed bacterial growth and all were gram positive. 48.6 were Staphylococcus aureus ; while 51.4 were Staphylococcus epidermidis. There was high sensitivity of Staphylococcus aureus to chloramphenicol (100); clindamycine (92); oxacilline (86.7); ciprofloxacine (76.7) and norfloxacine (71.9). However; there was a high resistance of Staphylococcus aureus to penicilline G (11.1) and tetracycline (52.8). Staphylococcus epidermidis was highly sensitive to chloramphenicol (71.9) and oxacilline (71.1) while it was resistant to erythromycine (28.6); norfloxacine (35.3) and penicilline G (40.6 In this study; all of the isolated pathogens were revealed to be gram-positive bacteria. Chloramphenicol; clindamycine and oxacilline showed good activity against normal flora of the ocular surface and should be used in prevention of post-operative end ophtalmitis