High Anion Gap Metabolic Acidosis among Children with Nodding Syndrome (NS) in Northern Uganda: Case Series.

Aims: To conduct a hormonal and biochemical studies on 10 patients with diagnosis of probable Nodding Syndrome (NS). Study Design: A cross-sectional study Place and Duration of Study: Atanga Health Center III in Pader District in Northern Uganda in September 2012. Methodology: We recruited consecutively 10 children with probable Nodding Syndrome who had been admitted for symptomatic management of seizures, injuries resulting from falls and nutritional rehabilitation. History, physical examinations, biophysical measurements (anthropometry) and blood investigations including serum electrolytes, liver function tests, thyroid hormones and vitamin D assays. Ethical approval was obtained from Gulu University Institutional Review Committee. Results: All children had severely low serum calcium and bicarbonate levels and a high Anion Gap. Thyroid hormones and vitamin D assays were largely normal. Conclusion: Children with Nodding Syndrome undergoing treatment for seizure control and nutritional rehabilitation have high Anion Gap metabolic acidosis.

Medical Education in Uganda - a critique

There is a growing concern that all is not well with undergraduate medical education in Uganda. Our medical schools are having difficulty in achieving their educational objectives. Undergraduate teaching is uneven in quality; variable in commitment and lacking in co-ordinated objectives. The consequence is that the students are losers. if medical students are losing out today; patients will lose out tomorrow. A large proportion of young graduates have limited communication skills; have a poor grasp of clinical logic; are uncertain in their choice of diagnostic tests; make poor decisions in prescribing and have a poor grasp of ethical principles. Even more alarmingly; a significant number of our senior medical students and house officers are deficient in basic clinical skills of taking a focussed history and making a physical examination. If these matters are to be rectified; we need a fundamental rethink of the role of our medical schools in producing the doctors of tomorrow. In this paper (monograph) I would like to examine the current state of our undergraduate medical education and attempt to highlight the relevant remedial steps