Incidence of and Risk Factors for Post-Operative Urinary Retention Following Surgery for Perineal Tears Among Ugandan Women: A Prospective Cohort Study.

INTRODUCTION AND HYPOTHESIS: We aimed to determine the incidence and risk factors for post-operative urinary retention (POUR) following surgery for perineal tears, and to determine the time to normal voiding after POUR. METHODS: This was a prospective cohort study of women who underwent surgery for old (≥ 3 months) obstetric perineal tears from January 2022 to December 2023. The diagnosis of POUR was made in a woman who completely failed to void despite a full bladder or, one who had post-void residual (PVR) > 150 ml within 10 min of voiding. Return to normal voiding was considered if a patient with POUR had two consecutive PVRs of ≤ 150 ml. Descriptive analyses and multivariable logistic regression were performed to determine risk factors for POUR. RESULTS: A total of 153 participants were enrolled in this study with a mean age of 35.9 (SD ± 10.8) years. The incidence of POUR was 19.6% (30/153, 95% CI 14.02-26.7), and the median time to normal voiding for these patients was 42.4 h (range 24-72). Risk factors for POUR included repeat perineal tear surgery (RR = 4.24; 95% CI 1.16-15.52; p = 0.029) and early urinary catheter removal (RR = 2.89; 95% CI 1.09-7.67; p = 0.033). CONCLUSION: Post-operative urinary retention following surgery for perineal tears is common. The time to return to normal voiding in patients with POUR is short. Women having repeat perineal tear surgery and those in whom the urinary catheter is removed early were more likely to experience POUR. Delayed urinary catheter removal could be considered, especially in patients undergoing repeat perineal tear surgery.

An Analysis of New York Data: Fluctuations in Hospital Capacity Are Driven by Variability in Elective Admissions and Discharge Activity.

Background Hospital overcrowding compromises patient safety. The contribution of variability in admissions and discharges to overall hospital capacity needs to be quantified. This study describes the statewide day-to-day fluctuation in the volume of hospitalized patients, the variability and pattern of hospital admissions and discharges throughout the week, and the contribution of Emergency Department (ED) vs. elective (non-ED) admissions and discharges to the overall variability in the system across the week. Methodology This is a retrospective analysis of the New York State Statewide Planning and Research Cooperative System database, in which all New York healthcare facilities submit patient-level data monthly. The study period was from January 01 to December 31, 2015. Outcomes included total volumes of admissions and discharges and length of stay sorted by patient origin (ED vs. non-ED admits (elective)) and service type (medicine vs. surgery) by day of the week. Results We studied 1,692,090 hospital admissions. Admissions were highest on Mondays and Tuesdays and steadily decreased throughout the week. There was little variability in the ED admissions throughout the week. Surgical elective admissions had significant variability throughout the week, with higher admissions at the beginning of the week. There was a significant difference (p < 0.01) between admissions on weekdays vs. weekends. Discharges increased from Monday to Friday, with a dramatic drop on the weekends, for both ED and elective pathways. Systemwide, on Monday, hospitals were 21% above the mean volume, and on Fridays, hospitals were 32% below the mean volume. Conclusions Overall hospital capacity shows dramatic variability throughout the week, driven primarily by elective admissions and discharges from any source throughout the week. Because elective admissions are schedulable, hospitals can reduce variability by smoothing scheduling. Increased weekend discharges will also improve capacity.

Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study.

BACKGROUND: Uganda has approximately 1.2 million people aged 15-64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS: We conducted a comparative cross-sectional study of 210 women aged 22-65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions. RESULTS: The overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1-21.4), with 23% (n = 47; 95% C.I: 17.8-29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2-17.1) in women not living with HIV (p < 0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n = 35) and women not living with HIV (80%; n = 20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27-4.42; p = 0.007). CONCLUSION: Premalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.

Omission of Breast Surgery in Exceptional Responders.

Breast cancer management has transformed significantly over the last decades, primarily through the integration of neoadjuvant systemic therapy (NST) and the evolving understanding of tumor biology, enabling more tailored treatment strategies. The aim of this review is to critically present the historical context and contemporary evidence surrounding the potential of omission of surgery post-NST, focusing on exceptional responders who have achieved a pathologic complete response (pCR). Identifying these exceptional responders before surgery remains a challenge, however standardized image-guided biopsy may allow optimized patient selection. The safety and feasibility of omitting breast and axillary surgeries in these exceptional responders are explored in ongoing clinical trials and the reported preliminary results appear promising. Moreover, understanding patient and physician perspectives regarding the potential elimination of surgery post-NST is integral. While some patients express a preference to omit or minimize surgery, the majority of healthcare providers are intrigued by the prospect of avoiding surgical interventions and endorse further research in this field.

Magnitude and trends in cervical cancer at Mbarara Regional Referral Hospital in South Western Uganda: Retrospective analysis of data from 2017-2022.

High-income countries have documented a significant decline in the incidence and mortality of cervical cancer over the past decade but such data from low and middle-income countries such as Uganda is limited to ascertain trends. There is also paucity of data on the burden of cervical cancer in comparison to other gynaecologic malignancies and there is a likelihood that the incidence might be on the rise. To describe the current trends and magnitude of cervical cancer in comparison to other gynaecological malignancies histological types, we conducted a retrospective records review of charts of patients admitted with gynaecological malignancies on the gynaecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022. Of 875 patients with gynaecological malignancies admitted to the MRRH in the 6-year review period, 721 (82.4%) had cervical cancer. Patients with cervical cancer were significantly older than those with other gynaecological malignancies: (50.2±11.5 versus 43.8± 15.0 respectively, p<0.001). Between 2017 and 2022, cervical cancer rates increased by 17% annually compared to other gynaecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046), with the majority of patients of cervical cancer patients (92.7%, n = 668) having squamous cell carcinoma. Most patients (87.9%, n = 634) had late-stage disease (stage 2 and above) and were referred to the Uganda Cancer Institute for chemoradiation. These results imply that there is a need to scale up screening services and other preventive measures such as vaccination against human papilloma virus.

Colonisation and its aftermath: reimagining global surgery.

Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.

Abnormal obstetric shock index and associated factors among immediate postpartum women following vaginal delivery at a tertiary hospital in southwestern Uganda.

BACKGROUND: Early recognition of haemodynamic instability after birth and prompt interventions are necessary to reduce adverse maternal outcomes due to postpartum haemorrhage. Obstetric shock Index (OSI) has been recommended as a simple, accurate, reliable, and low-cost early diagnostic measure that identifies hemodynamically unstable women. OBJECTIVES: We determined the prevalence of abnormal obstetric shock index and associated factors among women in the immediate postpartum period following vaginal delivery at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS: We conducted a cross-sectional study at the labour suite and postnatal ward of MRRH from January 2022 to April 2022. We systematically sampled women who had delivered vaginally, and measured their blood pressures and pulse rates at 1 h postpartum. We excluded mothers with hypertensive disorders of pregnancy. Sociodemographic, medical and obstetric data were obtained through interviewer-administered questionnaires. The prevalence of abnormal OSI was the proportion of participants with an OSI ≥ 0.9 (calculated as the pulse rate divided by the systolic BP). Logistic regression analysis was used to determine associations between abnormal OSI and independent variables. RESULTS: We enrolled 427 women with a mean age of 25.66 ± 5.30 years. Of these, 83 (19.44%), 95% CI (15.79-23.52) had an abnormal obstetric shock index. Being referred [aPR 1.94, 95% CI (1.31-2.88), p = 0.001], having had antepartum haemorrhage [aPR 2.63, 95% CI (1.26-5.73), p = 0.010] and having a visually estimated blood loss > 200 mls [aPR 1.59, 95% CI (1.08-2.33), p = 0.018] were significantly associated with abnormal OSI. CONCLUSION: Approximately one in every five women who delivered vaginally at MRRH during the study period had an abnormal OSI. We recommend that clinicians have a high index of suspicion for haemodynamic instability among women in the immediate postpartum period. Mothers who are referred in from other facilities, those that get antepartum haemorrhage and those with estimated blood loss > 200mls should be prioritized for close monitoring. It should be noted that the study was not powered to study the factors associated with AOSI and therefore the analysis for factors associated should be considered exploratory.

Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda.

BACKGROUND: Despite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or 'near miss' is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS: We conducted a prospective cohort study among women admitted for delivery at MRRH's maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes. RESULTS: We enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32-6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01-2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19-2.77). CONCLUSION: Maternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.

Bacterial isolates and antibiotic susceptibility among women with abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in southwestern Uganda: a cross-sectional study.

BACKGROUND: Abnormal vaginal discharge is a common complaint among women of reproductive age, affecting about one- third of all women. In resource-limited settings where access to laboratory services is limited, treatment is usually syndromic. This approach may result in ineffective treatment, with high recurrence rates and a potential of developing antibiotic resistance. This study aimed to determine the bacterial isolates and antibiotic susceptibility among women with an abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in Southwestern Uganda. METHODS: We conducted a hospital based cross-sectional study among 361 women aged 15-49 years, presenting with abnormal vaginal discharge at the gynecology clinic of Mbarara Regional Referral Hospital from December 2020 to June 2021. Demographic characteristics were collected using a structured questionnaire. We collected cervical and vaginal sterile swabs and subjected them to wet preparation and gram stain. The specimens were cultured for bacterial isolates. Susceptibility testing was performed on samples with bacterial isolates using the Kirby-Bauer disc diffusion method, on the commonly prescribed antibiotics in this setting. We summarized and described the bacterial isolates and antibiotic susceptibility patterns as frequencies and percentages. RESULTS: We enrolled 361 women with abnormal vaginal discharge. Bacteria were isolated in 29.6% (107/361) of the women, and the commonest isolates included; Staphylococcus aureus 48.6% (52/107), Klebsiella pneumoniae 29.9% (32/107) and Enterococcus faecalis 15% (16/107). Yeast cells were found in 17.7% (64/361) of the women with abnormal vaginal discharge. Cefuroxime (90.7%) and Ciprofloxacin (81.3%) had a high level of sensitivity while high levels of resistance were observed for Doxycycline (86.0%) and Azithromycin (67.0%). CONCLUSION: The common bacterial isolates were Staphylococcus aureus, Klebsiella pneumoniae and Enterococcus faecalis. The isolated bacteria were most sensitive to Cefuroxime and Ciprofloxacin but resistant to Doxycycline and Azithromycin. There is need for routine culture and susceptibility testing of women with abnormal vaginal discharge so as to guide treatment, minimize inappropriate antibiotic use and consequently reduce antibiotic resistance.

Retinopathy among women with hypertensive disorders of pregnancy attending hospitals in Mbarara city, south-western Uganda: a cross-sectional study.

OBJECTIVE: Retinopathy is one of the complications occurring among women with hypertensive disorders of pregnancy. We sought to determine the prevalence and factors associated with retinopathy among women with hypertensive disorders of pregnancy in southwestern Uganda. DESIGN: This was a hospital-based cross-sectional study from November 2019 to March 2020. SETTING: Three selected hospitals in Mbarara city, south-western Uganda. PARTICIPANTS: The study included all pregnant women with hypertensive disorders of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: The participants were screened for retinopathy using a fundus camera. Data on participant's sociodemographics, obstetrics and medical factors were collected. The prevalence of retinopathy was determined and multivariable logistic regression was used to determine the independent factors associated with retinopathy. RESULTS: A total of 216 women with hypertensive disorders of pregnancy were enrolled in this study. The prevalence of retinopathy was 60.2% (130/216). The most common retinal lesions were grade 1 retinopathy (narrowing of arterioles) accounting for 86.9% (113/130), grade 3 (retinal haemorrhages) was present in 10% (13/130) of women and grade 4 (papilloedema) in 3% (4/130). In an adjusted analysis, severe hypertension was significantly associated with retinopathy (aOR=2.8; 95% CI: 1.36 to 5.68). Grandmultigravida women were also associated with retinopathy (aOR=2.4; 95% CI: 0.99 to 5.72) with a tendency towards significancy, p=0.051. CONCLUSIONS: In our study, retinopathy was common among women with hypertensive disorders of pregnancy. Women presenting with severe hypertension were likely to have retinopathy. There is a need to integrate screening for retinopathy in the care cascade of women with hypertensive disorders of pregnancy.

Matching Kienböck's Treatment Options to Specific Features of Each Case.

Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck's patients through the early, transitional, and late phases of the disease.

Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda.

BACKGROUND: Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension. OBJECTIVE: This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda. STUDY DESIGN: This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension. RESULTS: A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; P=.03), controlling for age, gravidity, and eclampsia. CONCLUSION: Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.

Abdominal pregnancy with a live newborn in a low-resource setting: A case report.

Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in low-resource settings because of poor antenatal healthcare provision, low socioeconomic patient status as well as lack of adequate medical resources. Clinical diagnosis can be difficult and ultrasound scan is helpful during the early stages of gestation but can be disappointing thereafter. A case of abdominal pregnancy in a 25-year-old woman, who presented at 26 weeks of gestation with severe abdominal pain not relieved by any medication, is reported. An emergency laparotomy was undertaken as her vital signs deteriorated. An abdominal pregnancy was found and a live neonate delivered. Ministries of health in developing countries should ensure routine access to ultrasound in early pregnancy. Obstetricians should bear in mind that abdominal pregnancy can present late in gestation.

Sofropedagogía como estrategia de regulación motivacional para el aprendizaje de capacidades en Educación Física / Sophropedagogy as a motivational regulation strategy for learning skills in Physical Education

En un contexto de incertidumbre, estrés, incorporación de tecnología y procesos formativos híbridos se requiere de alternativas innovadoras sencillas y eficientes con posibilidades de mejorar la actuación y compromiso académico de los estudiantes en los procesos de enseñanza-aprendizaje del área de Educación Física (EF). El estudio tuvo por objetivo determinar el efecto de la sofropedagogía como estrategia de regulación motivacional para el aprendizaje de capacidades referidas al desarrollo de conciencia del esquema corporal y activación mental positiva en el área curricular de EF. Es una investigación cuasiexperimental con pre y post prueba sin grupo control, desarrollada en procesos formativos presenciales y no presenciales durante dos semestres académicos, con 150 estudiantes del ciclo inicial, intermedio y superior de la Escuela Profesional de Educación Física/Universidad Nacional del Altiplano, Puno-Perú. Los resultados destacan la factibilidad de incluir la sofropedagogía como un entrenamiento motivacional-inductor en los procesos formativos híbridos de enseñanza-aprendizaje, cuyos efectos en el aprendizaje de capacidades en EF fueron significativos: 0.000 menor a 0.05 según la prueba de rangos con signo de Wilconxon. Se concluye que la sofropedagogía ha mostrado otorgar opciones de autonomía-flexibilidad para planificar, ejecutar y monitorear acciones en relación a objetivos propuestos en el área de EF y se adapta fácilmente a calendarios, espacios y ritmos de aprendizaje individual-colectivo de los estudiantes de EF. (AU)

In a context of uncertainty, stress, incorporation of technology and hybrid training processes, simple and efficient innovative alternatives are required with the possibility of improving the performance and academic commitment of students in the teaching-learning processes in the area of Physical Education (PE). The study aimed to determine the effect of sophropedagogy as a motivational regulation strategy for learning skills related to the development of body schema awareness and positive mental activation in the PE curriculum area. It is a quasi-experimental research with pre and post test without control group, developed in face-to-face and non-face-to-face training processes during two academic semesters, with 150 students of the initial, intermediate and superior cycle of the Professional School of Physical Education / National University of the Altiplano, Puno. -Peru. The results highlight the feasibility of including sophropedagogy as a motivational-inducing training in hybrid teaching-learning training processes, whose effects on learning skills in PE were significant: 0.000 less than 0.05 according to the Wilconxon signed-rank test. It is concluded that sophropedagogy has shown to grant autonomy-flexibility options to plan, execute and monitor actions in relation to proposed objectives in the PE area and easily adapts to calendars, spaces and individual-collective learning rhythms of PE students. (AU)

Prevalence of gestational diabetes mellitus and associated factors among women receiving antenatal care at a tertiary hospital in South-Western Uganda.

INTRODUCTION: gestational diabetes mellitus is one of the major causes of morbidity and mortality among pregnant women worldwide. We aimed to determine the prevalence and factors associated with gestational diabetes mellitus among women attending the antenatal care clinic at a tertiary care hospital in South-Western Uganda. METHODS: this was a hospital-based cross-sectional study conducted among women at ≥24 weeks of amenorrhea attending the antenatal care clinic at Mbarara Regional Referral Hospital between December 2020 and March 2021. We screened all women for gestational diabetes mellitus using the World Health Organization 2013 diagnostic criteria. We obtained socio-demographic, medical, and obstetric data. Multivariable logistic regression was used to determine the factors independently associated with gestational diabetes mellitus. RESULTS: we enrolled 343 pregnant women with a mean age of 27.3 (SD ±12.3) years. Of the 343 participants, 35 (10.2%) had gestational diabetes mellitus (GDM) (95% C.I: 7.4%-13.9%) and 7 (2%) had diabetes in pregnancy. The factors significantly associated with gestational diabetes mellitus were; previous history of foetal macrosomia in any of the previous pregnancies (aOR: 5.53, 95% C.I: 1.29-23.65) and family history of diabetes mellitus in the first-degree relatives (aOR: 4.45, 95% C.I:1.48-13.34). CONCLUSION: one in every ten pregnant women attending the antenatal care clinic at Mbarara Regional Referral Hospital is likely to have gestational diabetes mellitus in pregnancy. There is a need to strengthen routine testing for gestational diabetes mellitus among women attending the antenatal care clinic, especially pregnant women with a prior history of foetal macrosomia and a family history of diabetes mellitus in first-degree relatives.

Long-term Outcomes for Late-Phase Kienböck's Tenoarthroplasty.

BACKGROUND: In late KienbÓ§ck's, the lunate is fully fragmented and nonreconstructible. Replacing the lunate with a pyrocarbon prosthesis preserves load distribution and avoids carpectomy or fusion, but leaves the wrist intrinsically unstable, requiring additional soft-tissue stabilization techniques. METHODS: Five men and 7 women with a mean age of 43 (±15) years underwent prosthetic replacement of the lunate with dual bundle scaphoid-triquetrum tenodesis for carpal stabilization. The mean follow-up interval from initial surgery was 9.1 (±1.7) years. Outcomes were Disabilities of Arm, Shoulder, and Hand (DASH) score, revision or conversion surgery, and wrist range of motion. RESULTS: The mean DASH score was 8.9 (±7.1). No patients reported any additional revision or conversion surgery. The mean wrist flexion was 60° (±14°); wrist extension was 45° (±21°). CONCLUSIONS: Clinical outcomes proved more favorable than anticipated, particularly the self-rated outcomes scores and the absence of any revision or conversion surgery.

Frequency, severity, and factors associated with clinically significant drug-drug interactions among patients with cancer attending Mbarara Regional Referral Hospital Cancer Unit, Uganda.

BACKGROUND: Cancer is a major public health problem with pharmacotherapy being the cornerstone of its management. Cancer patients receive multiple drugs concurrently risking Drug-Drug Interactions (DDIs). DDIs, though avoidable, can significantly contribute to morbidity, mortality, and increased healthcare costs in this population of patients. Currently, there is no published study from Uganda on clinically significant DDIs (cs-DDIs) among cancer patients. This study identifies frequency, severity, and factors associated with cs-DDIs at Mbarara Regional Referral Hospital Cancer Unit (MRRHCU). METHOD: A cross-sectional study was conducted among 300 cancer patients receiving chemotherapy from a tertiary care hospital in western Uganda from January-February 2022. A questionnaire and data collection form were used to collect patient data. Lexicomp® Drug interaction software was used to screen the patient drug information for DDIs and assess their severity. Predictors of DDIs were identified using logistic regression using SPSS (Statistical Package for Social Sciences). RESULT: Three hundred participants were enrolled with a mean age of 48 ± 23.3 years. One hundred eighty-one patients experienced 495 cs-DDIs; with a mean of 1.7 ± 2.2. The prevalence of cs-DDI was 60.3% (55.0-66.0% at 95% CI). Digestive organ neoplasms were the most commonly (80, 26.7%) diagnosed category, and 'plant alkaloids and other natural products were the most frequently (143, 47.7%) used chemotherapeutic drug classes. About three-quarters of cs-DDIs were rated as category C risk (367, 74.1%) whereas over two-thirds (355, 71.7%) were moderate in severity.. Being female (aOR = 2.43 [1.23-4.48 at 95% CI]; P-value = 0.011) and use of ≥ 6 drugs concurrently (aOR = 18.82 [9.58-36.95 at 95% CI]; P-value < 0.001)) were significantly associated with cs-DDIs. CONCLUSION: More than half of the participants experienced at-least one cs-DDI which is generally higher than what was reported in high-income settings. About three-quarters were category C and moderate in severity, and require enhanced monitoring for safety and treatment outcome. Being female and using ≥ 6 drugs were significantly associated with cs-DDIs.

Thinness among children aged 5-17 years living in Nakivale refugee settlement, South Western Uganda: a cross-sectional study.

BACKGROUND: Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5-17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda. METHODS: This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance. RESULTS: A total of 420 children aged 5-17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8-11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63-24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27-8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15-8.83, p = 0.025). CONCLUSION: Five in every 100 children aged 5-17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children.

Hypersensitivity Reaction to Carbon Fiber-Polyetheretherketone Composite Spinal Implant: A Case Report.

CASE: A 52-year-old woman presented with localized hypersensitivity symptoms immediately after insertion of a carbon fiber-polyetheretherketone (CF-PEEK) vertebral fusion device. After a modified cutaneous patch test confirmed an allergic reaction to the implant, the device was surgically removed. The patient's symptoms were largely resolved 1 month after the removal of the device. CONCLUSION: CF-PEEK is a commonly used biomaterial in surgical implants. As far as we know, this is the first reported case of a hypersensitivity reaction to CF-PEEK.

Pelvic Organ Prolapse and Its Associated Factors Among Women Attending the Gynecology Outpatient Clinic at a Tertiary Hospital in Southwestern Uganda.

Purpose: To determine the prevalence, clinical stage at presentation and factors associated with pelvic organ prolapse (POP) among women attending the gynecology outpatient clinic at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods: We conducted a cross-sectional study at the gynecology outpatient clinic of MRRH from September 2019 to January 2020. Women aged 18-90 years were systematically sampled and recruited into this study. An interviewer administered questionnaire was used to collect participants' socio-demographic, obstetric, gynecological and medical factors. POP stage was obtained by using the pelvic organ prolapse-quantification system. Multivariable logistic regression analysis was done to determine factors associated with pelvic organ prolapse. Results: Of 338 participants enrolled, the prevalence of POP was 27.5% [n = 93, 95% Cl: 23.0-32.5]. POP stages were stage I 11.8% (n = 11), stage II 63.4% (n = 59), stage III 16.1% (n = 15) and stage IV 8.9% (n = 8). Grand-multiparity (aOR 17.1, 95% CI: 1.1-66.6), birth weight more than 3.5kg (aOR 3.7, 95% CI: 1.1-12.6), perineal tears (aOR 6.5, 95% CI: 2.1-20.2), peasant farmer (aOR 6.9, 95% CI: 1.6-29.9) and duration of labour in the first delivery >24 hours (aOR 5.7, 95% CI: 1.2-29) were significantly associated with POP. Conclusion: POP is common among women attending the gynecology clinic at MRRH with most of them presenting with stage II. There should be routine screening for POP to enable early identification and management especially in those who are grand multiparous, peasant farmers and have a history of perineal tears.